Ehealth magazine october 2017

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VOLUME 12 / ISSUE 10 / OCTOBER 2017 / ` 75 / US $10 / ISSN 0973-8959

Medical Equipment Diagnostics

The Affordability Factor SPECIAL FEATURES

Higher GST on Medical Equipment Bad News for Health Industry Odisha’s Sampurna a New Beginning in Mother & Child Care PPP - A Potent Tool to Achieve Excellence in Healthcare

INTERVIEWS

HSCC’s Global Expansion HSCC Spreading its Wings to Serve the World Gyanesh Pandey, Chairman and Managing Director, HSCC (India) Limited

Industry Perspective Combating Cancer the Smart Way Taher Abbasi, COO and Co-Founder, Cellworks Research India Private Limited

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OCTOBER 2017 | VOLUME 12 | ISSUE 10

08 COVER STORY

Medical Equipment and Diagnostics The Affordability Factor HSCC’S GLOBAL EXPANSION 22

HSCC Spreading its Wings to Serve the World Gyanesh Pandey Chairman and Managing Director HSCC (India) Limited

FEATURE 16 Odisha’s SAMPURNA A New Beginning in Mother & Child Care 36 Lung Transplantation Another Glorious Chapter For PGIMER, Chandigarh 39

‘Technology Making a Difference in Today’s Medical World’ Dr Sameer Pagad Consultant Cardiologist, K J Somaiya Hospital Superspeciality Centre

42 PPP: A Potent Tool to Achieve Excellence in Healthcare

INDUSTRY PERSPECTIVE 18

One Life: Awareness on Nutritional Supplements Growing Gaurav Aggarwal Director, Lasons India Pvt Ltd

Combating Cancer Smartly Taher Abbasi COO and Co-Founder, Cellworks Research India Private Limited

Using Logistics to Lower Healthcare Costs Viren Sood Head Corporate Relations GoComet

Credihealth: A Credible Source of Medical Advice Ravi Virmani Founder and Managing Director, Credihealth

Data Driven Decisions Stimulating Healthcare Business Madhu Aravind CEO, Searchlight Health, a subsidiary of Piramal Group

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INDUSTRY OPINION 28

‘Higher GST on Medical Equipment Bad News for Health Industry’ Dr Dharmendra Nagar Managing Director, Paras Healthcare

Editorial Medical Equipment Vital to Make Indian Healthcare Affordable Expected to grow to $50 billion by 2025 as per the ‘Make in India’ sector survey, the medical device industry is experiencing a rapid expansion. Given this exponential growth, the government has set new rules and looking at ways to regulate the industry to make healthcare more affordable across the country. This resulted into recent capping of stent prices, even as plans are afoot to regulate prices of more medical devices. Our cover story, ‘Medical Equipment and Diagnostics -- The Affordability Factor’, highlights the impact of the government’s decision on the industry and how the expenditure on healthcare can be reduced to make quality healthcare accessible to all. This issue of eHealth magazine carries the interview of Gyanesh Pandey, Chairman and Managing Director, HSCC (India) Limited, a Schedule C company under the Government of India with ongoing projects in Sri Lanka, Myanmar, Nepal, Bhutan, Afghanistan and Bangladesh, which has recently bagged a project from the Government of Mauritius to develop the entire healthcare infrastructure of that country. Cancer has emerged as a major challenge for the healthcare industry and it is focus of a large number of research initiatives across the world. In an interview with eHealth magazine, Taher Abbasi, COO and Co-Founder, Cellworks Research India Private Limited talks about how personalised cancer care based on computer modelling of genomic testing data is changing the way cancer care is being delivered. The October issue of the magazine carries a number of features highlighting the latest developments in Indian healthcare space. The feature, Odisha’s SAMPURNA: A New Beginning in Mother and Child Care, underscores how the State has set the target for complete immunisation by 2018 and further reduction of IMR and MMR through this State budget programme. An industry article ‘Higher GST on Medical Equipment Bad News for Healthcare Industry’, opines if the patient has to be insulated from the increase in cost due to GST, the hospital has to bear the extra cost which will impact the ability of the healthcare providers to expand and reach out to more and more needy people. Elets will organise the 3rd Annual Healthcare Summit Rajasthan in Jaipur on November 10, followed by one more summit in Chhattisgarh. These summits will take forward the agenda of our past conferences in creating a robust and quality healthcare system in India. This issue also carries the conference report of National Food and Pharma Summit, held in Ahmedabad in August. It gives an insight into the advancements being made in the two sectors as also about the important issues concerning their growth. Looking forward to our readers’ invaluable feedback, I wish them all a Happy and Prosperous Diwali !

Dr Ravi Gupta Editor-in-Chief, eHEALTH magazine, & CEO, Elets Technomedia Pvt Ltd

COVER STORY

Medical Equipment and Diagnostics The Affordability Factor

A recent study by University of Washington’ points out the out-of-pocket personal spending on healthcare in India is a whopping 65.6 per cent – placing India at the sixth place with even countries like Sudan, Yemen, Azerbaijan, Nigeria and Cameroon ahead of it, writes Vivek Ratnakar of Elets News Network (ENN).

n the occasion of India’s 71st Independence Day, while speaking from the ramparts of Red Fort Prime Minister Narendra Modi called upon his countrymen to help him build a “New India”, “where there is equal opportunity for all; where modern science and technology

OCTOBER 2017 | ehealth.eletsonline.com

play an important role in bringing glory for the nation in the global arena”. Among the various government initiatives that he mentioned in his Independence Day speech, his vision of making healthcare affordable across

the country echoed the aspiration of millions of people. They often find themselves at the receiving end when it comes to access quality healthcare within their modest means. “Cheap medicines through Jan Aushadhi Kendras are a boon to

According to a study by University of Washington’s Institute for Health Metrics and Evaluation, the outof-pocket personal spending on healthcare in India was at whopping 65.6 per cent – placing India at the sixth place with only Sudan, Yemen, Azerbaijan, Nigeria and Cameroon ahead of us when it comes to outof-pocket expenditure done by an individual to access healthcare services. With about 750–800 medical device manufacturers in India, the medical devices industry in the country is at present valued at $5.2 billion, contributing about 4-5% to the $100 billion Indian healthcare industry, which is expected to reach $145 billion by 2018 and over $280 billion by 2025.

the poor. There used to be a lot of expenditure on operations and stents. We are striving to make it possible for knee operations as well. We are striving to minimise this expenditure for the poor and the middle class,” said the Prime Minister in his speech.

The Indian medical device manufacturers have an average turnover of Rs 450–500 million on an average investment of Rs 170–200 million, says a report by SKP Business Consulting LLP. India is also the fourth-largest medical devices market in Asia after Japan, China and South Korea. As per industry estimates, the Indian medical devices market will grow to $50 billion by 2025.

“Earlier there used to be dialysis only at the State capitals. Now we have decided to open dialysis centres at district level. We have already opened this facility in 350 to 400 districts where free dialysis services are available for the poor,” he added.

Given the rapid growth of medical devices manufacturing, the government has already notified the Medical Devices Rules, 2017 and is in the process of finalising the draft of Medical Device Regulation Bill for comprehensive regulation of the

medical devices in the country. However, the medical device industry urgently wants the government to resolve some pressing issues. The industry has been grappling for long and wants a set standard certification by a regulatory agency in place to deal with competitive edge the foreign device manufacturers have while participating in procurement tenders by government hospitals. “It’s unfortunate when governmentowned-and-financed hospitals discriminate against Indian manufacturers, instead of giving a preference to them. This is also in complete violation of the recent public purchase order by DIPP, and a circular from the Ministry Of Health, with tenders issued by public healthcare facilities run by Defence, AIIMS and even State governments continuing to specify compliance to both USFDA and CE certification,” says Rajiv Nath, Forum Coordinator, Association of Indian Medical Device Industry (AiMeD), a representative body of domestic medical device makers. “It’s ironical that to access our own market, we need to seek third-country regulatory approvals or certifications. The government should not finance such discriminatory tenders,” he adds. “Quality and innovation are key to building a strong healthcare ecosystem that is able to meet the current and future needs of all of India’s people, and the recently introduced price controls represent a step in the wrong direction toward this goal. Rather than addressing concerns surrounding affordability and accessibility, price controls lead to significant negative impacts, including new concerns over access to high quality care and impeded availability of the most advanced treatments and cures from the medical technology industry. The medical technology industry stands

ehealth.eletsonline.com | OCTOBER 2017

COVER STORY

More often than not, promises made by the government of the day end up hitting the roadblocks created by procedural ‘requirements’, but in this case action was followed soon. In the subsequent months, the government slashed the prices of medical devices like knee implants and heart stents by up to 75 per cent as part of its effort to make life saving devices more affordable for the patients.

COVER STORY

ready to work with all stakeholders toward sustainable, market-oriented alternatives,” says Abby Prett, Vice President, Global Strategy and Analysis, AdvaMed. The impact of Goods and Services Tax (GST) on the medical devices sector is also considerable with many industry players saying that it may derail the plan of the government to make healthcare available at an affordable cost. “Considering the massive healthcare requirements and the need for healthcare infrastructure in India, the Narendra Modi government has rightly kept the healthcare sector outside of the otherwise overarching Goods and Services Tax (GST) regime. However, the fine print of the roll out of the GST in the country and the taxes on many of the inputs that the healthcare industry requires obviates the very reasons why healthcare has been kept out of the GST net,” says Dr Dharmendra Nagar, Managing Director, Paras Healthcare. “The final increase in the prices of a lot of medical equipment is currently being absorbed by the healthcare providers. But in the process, the ability of the healthcare providers to expand to newer geographies and make a difference to the lives of people is being compromised. While initially healthcare providers are bearing the increased costs, there will be a time when they will find it unviable. This is when they will start looking at ways to pass on the increase to the patients, making the cost of treatment more expensive for them,” Dr Nagar warns. Medical devices, including surgical instruments, used to attract 6 per cent central excise duty and 5 per cent Value Added Tax (VAT) and along with CST, Octroi, entry tax, etc. it comes to more than 13 per cent. With the new GST regime, the rate is 12 per cent – a decrease of mere 1 per cent.

OCTOBER 2017 | ehealth.eletsonline.com

MAKE IN INDIA PUSH FOR MEDICAL DEVICE MANUFACTURING There are a range of medical device clusters that have emerged due to supportive state-level policies as well as the availability of skilled labour. There are a few Medical Device Parks planned across India, including Andhra Pradesh MedTech Zone Limited (AMTZ), a park in Sultanpur village (Telangana) and HLL Lifecare Mediparks in Tamil Nadu, Maharashtra and Gujarat. AMTZ recently signed a Memorandum of Understanding (MoU) with the Board of Radiation and Isotope Technology (BRIT) for setting up of one radiation processing facility for medical products in India using Cobalt – 60 irradiation technology for large scale irradiation. The MoU was signed by Dr Jitendar Sharma, Managing Director and CEO, AMTZ and G Ganesh, Chief Executive, BRIT. This MoU will enable manufacturers at AMTZ to access the world class Gamma irradiation facility, which is being setup in a PublicPrivate- Partnership (PPP) mode in India. This facility will be available at a highly subsidised rate for all manufacturers who will be manufacturing at AMTZ. Gamma irradiation enables fast turnaround time and is highly effective because of its ability to easily penetrate package and product. Under the MoU, BRIT will help AMTZ with process technology, training to plant operators and support in establishing and standardising dosimetry. AMTZ would also include facilities such as electro-magnetic interference laboratory, 3D designing and printing for medical grade products, X-ray tube and radiation testing centre, rapid prototyping centre, metal molding and metal finishing centre, warehousing and regulator’s office. of healthcare sharply in the next decade. A vibrant and profitable private sector is critical for success. By proactively listening to and understanding each other better, the government and industry can collaborate effectively to realise the vision of the 2017 National Health Policy,” says Ravindranath Menon, Senior Business Adviser, SKP Business Consulting LLP. The medical device industry is highly technology-driven, innovative and a rapidly advancing industry globally. It is an industry that is changing the face of healthcare worldwide, impacting and improving diagnosis, treatment, and delivery. “The healthcare and medical device industries are at a critical threshold where growth can be significantly accelerated to ensure that India embraces the benefits of advancing medical technology to uplift standards

The government is starting to move in the right direction by segregating medical devices from drugs. But more work is required. Improved understanding of significant differences between the two subsectors will continue to help shape an appropriate policy. Key to this is an appreciation of the industry’s technology and innovation lifecycle, and a willingness to reward technology and continuing innovation since India has a long way to go in this sub-sector, given the current industry size.

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HSCCâ&#x20AC;&#x2122;S GLOBAL EXPANSION

HSCC SPREADING ITS WINGS TO SERVE THE WORLD HSCC, a Schedule C company under the Government of India with ongoing projects in Sri Lanka, Myanmar, Nepal, Bhutan, Afghanistan and Bangladesh, has recently bagged a project from the Government of Mauritius to develop the entire healthcare infrastructure of that country. Gyanesh Pandey, Chairman and Managing Director, HSCC (India) Limited, speaks about the companyâ&#x20AC;&#x2122;s vision and its growth trajectory in an interview with Souvik Goswami of Elets News Network (ENN).

Gyanesh Pandey

Chairman and Managing Director HSCC (India) Limited

HSCC has recently bagged some projects in Mauritius. Please provide us some details about it.

experience in developing healthcare infrastructure should spread in all those countries too.

In the last more than two years, we were trying to get some new work outside India. We have been working in Sri Lanka, Myanmar, Nepal, Bhutan, Afghanistan and Bangladesh. But the project we bagged in Mauritius was from the grant of the Indian Government to that country. We had been trying to get some work from African countries directly because we had done enough projects in India and SAARC (South Asian Association for Regional Cooperation) countries in the last over 35 years. I always thought that our knowledge and

We discussed this with the Health Minister of Mauritius when he came here. After going through our profile and our work in India and abroad, he realised that there is an agency that can deliver world-class projects in time. Later, he called us to Mauritius.

OCTOBER 2017 | ehealth.eletsonline.com

After we were assigned the first project, over time they decided to give us two more projects. Recently, when we visited Mauritius the Government of Mauritius asked us to develop the entire healthcare infrastructure project of their

country. This happened only because of knowledge sharing with them through regular meetings and communication on what all HSCC can do. They saw our performance through our website and the quality of the projects we have completed in the past. Now we have to improve their entire healthcare infrastructure starting from mediclinics, which are like the Primary Health Centres in our country, to tertiary and top medical care facilities like Victoria Hospital that is similar to AIIMS in our country. Very soon, may be in the next 2-3 months, we are going to start few

What is the total cost of the projects you have undertaken in Mauritius?

We have undertaken various projects in Mauritius. The amount so far we worked out is for only two-three projects. Like the cost of building the ENT hospital is around Rs 200 crores. The cost of 1,000-bedded hospital we are building there has been worked out to be not less than Rs 1,000 crores and the medical college would be of around Rs 1,200 crores. The cancer hospital will also be of not less than Rs 200-300 crores. There are around 10-11 projects there. Considering all those together, the total initial cost may reach around Rs 2,500 crores. The cost may go further up because once we start working there may be few more things to add on. We will be able to deliver the projects in the next two-three years’ time.

Are you building these hospitals anew?

All these hospitals are already operational, but the space, technology and infrastructure were set up around 50-70 years ago. So, the infrastructure and facilities there are outdated. We are completely demolishing the existing ENT hospital and building a new one in its place. But the eye hospital is a totally new hospital. Currently, it is operating in some other location but once the building is completed, the hospital will be shifted there. In India, we have one doctor on a population of 1,700, but there a doctor is available for a population of 250. Even the number of nurses and technicians available per head in Mauritius is more than in India. The facilities available in Mauritius are far better than India. For example, they keep a count of their dialysis patients and their details are known to the health authorities. A well-equipped ambulance visits a patient’s home, get the patient into the ambulance and then to the hospital; the

AS FAR AS FINANCIAL GAINS ARE CONCERNED, WE DID AROUND 89 CRORES WORTH OF WORK IN THE YEAR I TOOK OVER. THAT VALUE THIS YEAR HAS REACHED AROUND 1,600 CRORES. THE TOTAL WORK WHICH WE HAVE UNDERTAKEN NOW IS TO THE TUNE OF Rs 20,000 CRORES.

patient receives the treatment and then dropped at home. There is door-todoor healthcare facility in Mauritius. Though technically our hospitals in cities are much advanced, we are not able to provide such kind of service due to heavy population pressure.

Which other countries HSCC is focusing on to spread its wings?

We have a clear focus on establishing our presence in all African countries. Mauritius is the first country where we have been able to do that. There are other African countries where Indian agencies are actively working. As per our study, a good healthcare infrastructure is badly required by every African country. Very soon, we will be able to establish ourselves in all African and SAARC countries.

What kind of smart healthcare technologies are you using to implement your projects?

Smart healthcare means that there are no physical barriers to getting

ehealth.eletsonline.com | OCTOBER 2017

HSCC’S GLOBAL EXPANSION

of the projects in Mauritius. We also have to prove that an Indian Government agency can work fast and deliver quality within the budget allocated to us.

HSCC’S GLOBAL EXPANSION

doctor’s appointment, accessing diagnostics test results, keeping the patient records and availing the medical treatment. Presently, we are ensuring that the patient should visit the hospital to receive all the treatments without any problem with the help of smart techniques, which we call smart healthcare. Smart healthcare also means that ICT is used to book appointments from home and every medical record is available on a chip to allow you to access it from anywhere in the world. It should also ensure that the entire history of a patient is available on the mobile. The operation theatres should be equipped to take advice from other experts present anywhere in the world in real time. Since we have already reached this level, the Mauritius government has given us the mandate to start developing their e-health infrastructure as well.

OCTOBER 2017 | ehealth.eletsonline.com

Recently there have been some merger talks going on with HSCC. What is your vision for HSCC in the next few years in terms of its financial growth? The merger talks could happen because HSCC has grown tremendously in the past five years. That is one of the reasons that a company like HSCC has been identified for mergers. HSCC is a Schedule C company and it had less than 100 employees few years back. The turnover of the company was less than 100 crores when I joined the company. So, nobody could think that HSCC can also be one of the big players and can be merged with some other company. But in the last five years, HSCC has started working in more than 100 places and we have achieved a CAGR of 33 per cent, which looks almost impossible for any PSU or private organisation. Our presence is in every small town in India. Considering all these things HSCC was identified for a merger.

This company has developed a great skill in developing healthcare infrastructure and it should always be recognised for building quality healthcare infrastructure in India. HSCC should be further strengthened so that the skills acquired in its 35 years of existence can be retained and utilised for government public and private healthcare sector in India and abroad. As far as financial gains are concerned, we did around 89 crores worth of work in the year I took over. That value this year has reached around 1,600 crores. The total work which we have undertaken now is to the tune of 20,000 crores. We have just started Rs 5,000 crores worth of work and around Rs 12,000 crores worth of work were already going on. Our work speaks for itself and we don’t believe in advertisements. The merger should happen as per the government’s plan, but the capability, strength and the technical competence of this company should be retained.

FEATURE

ODISHA’S SAMPURNA

A New Beginning in Mother & Child Care

fter achieving highest point decline in Infant Mortality Rate (IMR) than the national average, Odisha government recently launched a programme to arrest the IMR and MMR further in the state. The government launched – SAMPURNA -- (Sishu Abond Matru Mrityuhara Purna Nirakaran Abhijan) programme under the State budget to increase institutional

OCTOBER 2017 | ehealth.eletsonline.com

deliveries in order to reduce infant mortality rate (IMR) as well as mother mortality rate (MMR). As per the new scheme, pregnant women from inaccessible areas reaching hospitals by arranging vehicles on their own will get Rs 1,000. The state is estimated to spend Rs 6 crore per annum under the SAMPURNA scheme.

Odisha has emerged ahead of other states on many health services parameters in last 16 years. Topping the highest point decline in IMR and MMR than the national average, Health and Family Welfare Department and State National Health Mission sets the target for complete immunisation by 2018 and further reduction of IMR and MMR through the state budget programme ‘SAMPURNA’. Biswajit Sahoo of Elets News Network (ENN) analyses the progress in the State health sector.

In a special programme of National Health Mission, Chief Minister Naveen Patnaik launched the programme. The government will provide financial support for pregnant women from difficult villages where 102/108 ambulances or fourwheeler vehicle cannot reach, Chief Minister Naveen Patnaik said while announcing the new scheme.

Under the revised National Health Mission Programme, the state government also launched ASHA Kalyan Yojana which would ensure a minimum monthly incentive of Rs 1,000 to each Asha worker. This scheme will benefit more than 47,000 ASHA workers working in different parts of the state. This will address the mobilisation of patients to access institutional health care as the Asha workers have major contribution to control IMR and MMR. The State government also launched NHM Employees and Welfare Fund which provides for compensation of up to Rs 6 lakh for death or permanent disability above 80 per cent and compensation up to Rs 2.5 lakh for partial disability. It will also provide for reimbursement of the cost of medical expenses up to Rs 3 lakh in a year for the critical health condition. The IMR in Odisha which was 96 per 1,000 births in 2,000 has been reduced to 40 in 2015-16, according

to the 4th round of the National Family Health Survey (NHFS) 201516. During the same period, the national average of IMR has reduced by 27 points as it has come down to 41 from 68. As per the latest NHFS report, state has achieved a sharp increase in institutional deliveries, family planning and ante-natal care of mothers and performed better than the national average on indicators like under-5 mortality rate, underweight, malnourishment and total fertility.

• Full immunisation coverage in the State was around 79 pc against the national average of 62 per cent • Achievement of the State was further scaled up to around 84 per cent in INCHIS of 2016 • Odisha is the only State where only one district and one ULB have been taken up under IMI

Health and Immunisation Survey (INCHIS) of 2016.

Odisha Tops Immunisation Chart: Apart from IMR and MMR indicators, Odisha has also performed better than other states in covering full immunisation, another important health services indicator. With 84 per cent coverage of full immunisation of children and pregnant women, Odisha has emerged as lead performer in the country. As per the National Family Health Survey – 4 (NFHS4) of 2015-16, full package immunisation coverage in 29 of 30 districts was found more than 84 percent. A recent assessment by the state level committee showed that as per NFHS4 of 2015-16, full immunisation coverage in the State was around 79 per cent against the national average of 62 per cent. The achievement of the State was further scaled up to around 84 per cent in the Integrated Child

“The Health and Family Welfare Department has chalked out plans to ensure 100 per cent immunisation coverage of children and pregnant women on head count basis in the districts where IMR and MMR rate was found high,” said Dr Pramod Kumar Meherda, Commissioner-cumSecretary, Health and Family Welfare Department, Government of Odisha. As the Ministry of Health and Family Welfare has drawn up an aggressive action plan to achieve full immunisation coverage target by 2018, the State Government has decided to deepen the activities under Intensified Mission Indradhanush (IMI) in one district and one ULB namely Ganjam and Bhubaneswar Municipal Corporation (BMC) because of comparatively less immunisation coverage in these areas. Odisha is among lead performing states in pulse polio immunisation campaign launched in 1995, Hepatitis-B programme implemented in 2011, pentavalent vaccination and maternal and neonatal tetanus elimination (MNTE) programme in 2015 and injectable polio immunisation drive introduced in 2016. It was decided to start Missile Rubella (MR) campaign from January, 2018 in the State.

ehealth.eletsonline.com | OCTOBER 2017

FEATURE

“The Health and Family Welfare Department plans to cover 7,853 villages spread over 30 districts would be covered under the SAMPURNA scheme. It is expected that more than 60,000 pregnant women would be benefited annually. The scheme will be helpful in increasing institutional deliveries in inaccessible areas,” said Dr Pramod Kumar Meherda, Commissioner-cumSecretary of Health and Family Welfare Department.

INDUSTRY PERSPECTIVE

ONE LIFE: Awareness on Nutritional Supplements Growing Given the size of our population we should have been a fairly large user. Awareness amongst the people is limited. However it is growing pretty rapidly, says Gaurav Aggarwal, Director, Lasons India Pvt Ltd, the parent company of One Life, in an interview with Elets News Network (ENN).

Gaurav Aggarwal Director Lasons India Pvt Ltd

Please apprise us about the One Life brand.

One Life is a brand focusing on nutrition-wellness-beauty. The nutrition and wellness have been rolled out in the market and the beauty products will come in near future. The brand has been established to provide the consumer with supplements and other related products for a healthier life. Our products include products for bone health, cartilage health, heart health, multi vitamins for men and women, Omega 3 fish oil, etc. In the coming months we are also introducing various products for womenâ&#x20AC;&#x2122;s health, diabetes control, liver health, kidney health, etc. The idea is to be able to provide the consumer with various products for various ailments.

How did you manage to establish the brand? Establishing just the brand in

OCTOBER 2017 | ehealth.eletsonline.com

itself is not very difficult. However, establishing a health supplement brand such as ours involves a lot of research and development amongst other things. Given the fact that we are a pharmaceutical manufacturer with more than 30 years of experience in India and internationally, the process was lengthy but not so difficult. Being vitamin producer ourselves and catering to more than 85 countries we very well understand the requirements of the consumer and the need for providing the same with the best quality products.

What is the current status of nutritional supplements market in India?

We are a manufacturer of vitamins (API). Our customers include the top brands of supplements across the globe. The Indian nutrition and supplement industry is at its nascent stage. Given the size of our population we should have been a fairly large user. Awareness amongst

the people is limited. However it is growing pretty rapidly. As social media and other avenues reach the length and breadth of the country, the awareness of the needs for supplements of various kinds increases too. Doctors and other experts also understand and appreciate the need for supplements as our diets do not provide adequate nutrition in the food we consume. However, our bodies require a certain amount of nutrition which can then be received by supplements such as ours. These are lifestyle and wellness products and are consumed for prevention rather than cure.

Can you share with us future plans of Lasons India and its product line?

The future plan is to develop various products in nutrition, wellness and beauty. We also plan to expand our reach across India and internationally.

INDUSTRY PERSPECTIVE

Combating Cancer SMARTLY One of the great challenges in cancer is identifying who will be cured by a treatment and who will suffer from cancer relapse. This has driven to todayâ&#x20AC;&#x2122;s personalised cancer care of computer modelling of genomic testing data, says Taher Abbasi, COO and Co-Founder, Cellworks Research India Pvt Ltd in conversation with Vivek Ratnakar of Elets News Network (ENN).

Taher Abbasi

COO and Co-Founder, Cellworks Research India Private Limited

Why personalised cancer treatment is so important? What are the inherent advantages?

The treatment decisions without precision medicine are based on one-size-fits-all guidelines with low response rates. With precision medicine driven personalisation, treatment decisions are influenced by understanding the relevant genomic characteristics of the patients. The rapid identification of the right therapy would benefit the patient in the best possible manner. If efficacious treatment can be delivered earlier in the disease progression, it mitigates unwarranted side-effects.

there has been mainstream clinical access to DNA sequencing to understand the gene misspellings for a patient. This is allowing cancer doctors to use genomics medicine testing as a way to better understand their patientsâ&#x20AC;&#x2122; cancer.

What is the scope of precision medicine in India?

There are significant differences in genomics or attributes of cancer patients across geographies. The implication of this is that therapies developed and tested in other countries could have different response rates in Indian patients. Indian Council of Medical Research projects over 1.7 million new cancer cases per year. Genomics medicine diagnostics to measure local population specific tumour genomic attributes is available. Hence, a big need and scope for deploying and adopting precision medicine in India.

However, one of the greatest challenges with cancer genetic information understands it. The average cancer contains hundreds of gene misspellings. It is impossible for the human brain to map this high number of abnormalities and their interactions. More importantly for the cancer patient, it is impossible for the human brain to consider the impact of hundreds of drugs on these hundreds of gene mutations.

In the last one decade, the cost and time for testing gene abnormalities have dramatically reduced. Recently,

This has driven to todayâ&#x20AC;&#x2122;s personalised cancer care of computer modelling of genomic testing data.

The latest developments in the area of precision medicine are

Please apprise us on the evolution of personalised cancer care.

OCTOBER 2017 | ehealth.eletsonline.com

Please share with us some latest trends in research and development in this field -- both in India and across the world.

How does understanding of cell biology help doctors in providing personalised cancer care to patients? One of the biggest challenges in cancer is identifying who will be cured by a treatment and who will suffer from cancer relapse. In cancer, there are misspellings or mutations in important genes that drive the cell to grow out of control and eventually move around the body. Different patients have different misspellings and hence do not benefit from same treatment. The average cancer contains hundreds of gene

mutations. Using computers to understand the unique cell biology of a patient by interpreting the high number of gene misspellings and their interactions help doctors evaluate efficacy impact of thousands of treatment permutations.

INDUSTRY PERSPECTIVE

treatment personalisation and disease monitoring. The idea is to predict response to a therapy enabling personalisation. This is done by taking into account the patient gene misspellings obtained from genomic medicine. Disease monitoring supports treatment personalisation and adaptation by early detection and tracking disease response to treatment. This closed loop of treatment personalisation and monitoring is the new precision medicine paradigm.

Which healthcare facilities in India you think are wellequipped with providing personalized care to treat cancer sub-types? Access to genomics medicine diagnostics and precision medicine platforms are available across all major health institutions in India.

How costly is personalised cancer treatment?

The human and economic cost of not selecting the right cancer treatment for a patient is very large. Typical response rates of drug agents is 30 per cent or less, implying more than 7 out of 10 patients would get a treatment which is expensive and toxic but would not work. The rapid identification of the right therapy and using precision medicine treatments offers health economic benefits.

ONE OF THE GREAT CHALLENGES IN CANCER IS IDENTIFYING WHO WILL BE CURED BY A TREATMENT AND WHO WILL SUFFER FROM CANCER RELAPSE. IN CANCER, THERE ARE MISSPELLINGS OR MUTATIONS IN IMPORTANT GENES THAT DRIVE THE CELL TO GROW OUT OF CONTROL AND EVENTUALLY MOVE AROUND THE BODY.

ehealth.eletsonline.com | OCTOBER 2017

INDUSTRY PERSPECTIVE

Using Logistics to Lower Healthcare Costs As healthcare products are largely temperature sensitive and fall in the perishable category, most pharma companies use air services as their preferred mode of transport. However, despite the obvious advantages of air transport, minor mishaps in coordination can lead to the consignment missing the scheduled flight which may have cost implications for a company, writes Viren Sood, Head Corporate Relations, GoComet, for Elets News Network (ENN).

Viren Sood

Head Corporate Relations GoComet

wing to various reasons, including lifestyle, there has been a surge in health related issues and medical cases among the general population. This has consequently led to an increase in the demand for healthcare products and services, which have also seen their costs rise, making them unaffordable to the common man. In India, the healthcare industry is expected to touch $160 billion by the end of the year and $280 billion by 2020. To allow the masses have better access to healthcare, the right approach would be to lower the costs involved in procurement and transportation, which will reduce the overall price of products. In the process of procurement of healthcare goods, besides production,

OCTOBER 2017 | ehealth.eletsonline.com

logistic costs play a major role in determining their prices, and are particularly higher in cases of international imports. In a report published by McKinsey, it was reported that for pharma companies, logistics makes up 25 per cent of their operating costs.

freight forwarder (agent who coordinates between the former two), customs housing agents, etc.

Logistics, as a service, is process driven and besides the time taken for shipment, involves various steps, which add to the length of the process. In cases of air shipments, transit time takes a maximum of five days, as compared to ocean, which can range from a week to 45 days.

As healthcare products are largely temperature sensitive and fall in the perishable category, most pharma companies use air services as their preferred mode of transport. However, despite the obvious advantages of air transport, minor mishaps in coordination may lead to the consignment missing the scheduled flight which may result in the need to book an immediate flight, obviously at a much higher cost.

Additionally, there are the processes of warehousing, quality checks, custom clearance and the involvement of stakeholders like the manufacturer, transporter of goods,

Through the Internet of Things and Artificial Intelligence, logistic analysis platforms help in avoiding such scenarios as all the steps involved in shipment are

When using ships as a mode of transport, a reefer is employed to ensure product quality is maintained till the time the product reaches the destination. Reefers are special temperature controlled containers, which ensure cold chain movement takes place, to avoid product wastage. For the pharma industry, cold chain management is expected to cost them $17 billion by 2020. If this materialises, companies stand at a risk of lesser profits and lack of business. To minimise this, there are various systems which help show you real time temperature reports. As seen, the most common problems faced in movement of sensitive cargo are in coordination and maintenance of temperature. Healthcare providers, manufacturers and distributors also struggle with problems of procurement processes. Another challenge faced by the

healthcare sector, is that of disparate proprietary data among medical devices and location information. The processes of continuously translating this data can also cause several errors and prevent healthcare companies from achieving efficiency. The healthcare sector still largely functions using manual processes, which not only allows more room for error and a significant amount of rework, but can also have larger implications. Cases of expired inventory, clinics receiving the wrong product, order errors, etc. are common place and there is an urgent need to find a solution for this. While other sectors have already implemented e-ordering, product scanning and order accuracy controls as key processes in improving their supply chains, the healthcare industry has a long way to go to catch up with them. By taking advantage of technology and newer intelligent systems, we address both issues with ease to ultimately lower costs

THE HEALTHCARE SECTOR STILL LARGELY FUNCTIONS USING MANUAL PROCESSES, WHICH NOT ONLY ALLOWS MORE ROOM FOR ERROR AND A SIGNIFICANT AMOUNT OF REWORK, BUT CAN ALSO HAVE LARGER IMPLICATIONS. CASES OF EXPIRED INVENTORY, CLINICS RECEIVING THE WRONG PRODUCT, ORDER ERRORS ETC. ARE COMMON PLACE AND THERE IS AN URGENT NEED TO FIND A SOLUTION.

incurred in both international and domestic logistics. Today, a lot of companies have understood the need for technology in logistics and have already begun adopting it to solve various problems and increase efficiency. Early adopters of this technology have already begun to see the long-term advantages and are reaping the benefits. Besides being confident that other players will gradually follow suit, we see technology as the ideal solution for reducing healthcare costs through logistics.

ehealth.eletsonline.com | OCTOBER 2017

INDUSTRY PERSPECTIVE

automatically monitored and scope of error is reduced to a minimum.

INDUSTRY PERSPECTIVE

CREDIHEALTH: A Credible Source of Medical Advice With an objective to create ease in availing medical services, Credihealth offers one of the largest hospital networks in India and helps people avail credible and reliable answers to their medical issues promptly, says Ravi Virmani, Founder and Managing Director, Credihealth in conversation with Rajbala of Elets News Network (ENN).

Ravi Virmani

Founder and Managing Director, Credihealth

How is Credihealth helping patients to connect with the right hospitals and doctors?

Credihealth helps people deal with all non-clinical pain points during their hospital journey. It is a patient-centric marketplace for healthcare providing end-to-end services and where one can take detailed notes on treatments, access literature, book appointments, avail tele-consult and videoconsult facilities with doctors and calculate expenses. We provide a priority appointment with the right doctor at no extra cost with the help of our in-house team of doctors. Additionally, each patient is assigned a medical expert who personally understands the medical symptoms and offers the

OCTOBER 2017 | ehealth.eletsonline.com

most appropriate options. Also, they can book an appointment with the right medical specialist and also get a second opinion through the platform along with timely updates during the course of the treatment. With Credihealth, the anxiety related to being overcharged for medical treatments is taken out of the equation. Patients can compare estimated treatment cost online, share reports and get treatment cost from top hospitals. Patients can also avail video consult with top surgeons for second opinion exclusively on credihealth platform. For video consultation, one does not need to have any app download or fancy tech. Just get a link on SMS and video consult on the browser.

What is the USP of Credihealth?

The USP of Credihealth lies in its contribution to hospitalisation industry while other players in the e-healthcare services market solely focus on the stand-alone clinics, individual doctors and outpatient consults. Credihealth is not just a â&#x20AC;&#x2DC;book appointmentâ&#x20AC;&#x2122; site, it provides personalised services to each and every patient at transparent pricing. Credihealth does not charge anything. Patients have to pay only to the hospitals. Credihealth guides patients through their entire hospitalisation journey making sure they go through minimum hassles during their tough times.

As an end-to-end solution provider in healthcare sector, how do you see advances in

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technology impact the healthcare industry and bringing transparency? Healthcare platforms support patients through the entire experience of their hospital journey. Advancements in technology are bringing more transparency in this sector. Transparency in pricing and online appointment booking tools allow consumers to identify and use discrete, best-in-breed health services from a range of providers. Technology has created transparency in the healthcare system which empowered people to make informed healthcare decisions, with the help of verified reviews, price comparisons, multiple treatment options and a belief that now there’s a better way!

Tell us about Credihealth’s medical tourism initiative and its objectives. Have you initiated any partnership in this regard? In order to tap the market of Medical Tourism and offer overseas patients world-class assistance in compliance with international accreditation standards, Credihealth with its specialised assistance aims to bridge the gap of the unorganised segment of medical tourism and protect international patients from getting cheated. Through this initiative, Credihealth aims to eliminate the woes of international patients and bring about a positive insight in the Indian healthcare ecosystem. An overseas patient visiting India for the first time need not worry about the hospital formalities. Our assistance is not limited to treatments alone, we ensure that an overseas patient is able to conveniently plan the trip and avail of myriad benefits with the help of our services. We believe that the initiative will give a significant push to India’s medical tourism market and will be our contribution to the

OCTOBER 2017 | ehealth.eletsonline.com

government’s vision of making India a prime destination for medical and healthcare assistance. Credihealth has associated with NABH and JCI-accredited hospitals of Delhi NCR, Mumbai, Chennai, Hyderabad, Kolkata, and Bangalore to offer overseas patients world-class assistance in compliance with International Accreditation Standards. Credihealth supports international patients by catering to all aspects of patient care management that includes pre-arrival requirements like VISA, scheduling appointments, accommodation, and discharge process. In order to provide stay and travel assistance to families, Credihealth has partnered with online hotel aggregators, Oyo and Treebo. Credihealth has already tied-up with over 630 hospitals in tier 1 as well as tier II cities, out of which mostly are NABH and JCI-accredited hospitals. These hospitals are capable enough to offer overseas patients worldclass assistance in compliance with International Accreditation Standards.

Can you highlight the factors deserving credit for growth of medical tourism in India?

India is one of the fastest growing medical tourism destinations in the world. The high-skilled specialists in the country, combined with the lowest medical cost and world-class healthcare services are what make India a sought-after destination for healthcare serviceability. Patients who travel abroad for medical treatment do so for a variety of reasons. Patients from developing countries look for treatment in India not available in their own countries. Thus, the medical tourism in India is seeing the arrival of patients from

our neighbouring countries. The cost differential is huge; those who come from the western side of the world look for treatments that cost five to 10 times in their own country and rush to India also to avoid the huge waiting period for many routine procedures. Quality of service and treatment the hospitals provide: India is famous for its large number of highly-qualified doctors. JCI (Joint Commission International) and NABH (National Accreditation Board for Hospitals & Healthcare Providers) are two globally recognised healthcare quality standards and India has more than 30 JCI accredited hospitals and around 425 NABH accredited hospitals A visa-on-arrival proposal or E-visa for tourists from chosen nations which permits foreign nationals to visit India for 30 days medical reasons has also spiked up the market of medical tourism in India. English is one of the official languages in India and almost universally adopted in the medical institutions. Most of the people in the country speak the language or are at least familiar with it. This makes the stay and the whole process much easier when compared to any other country. Also, hospitals and healthcare firms arrange interpreters or translators for patients from abroad to make them feel comfortable and easy while communicating.

What is the potential of medical tourism for future development and progress of the country?

The medical tourism industry in India has been growing at a rate of more than 20 per cent since 2011. At present, the industry stands at $3 billion. It is estimated that by 2020, the net worth of the industry is expected to touch or even cross the $8 billion mark.

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INDUSTRY OPINION

â&#x20AC;&#x2DC;HIGHER GST ON MEDICAL

The fine print of the roll out of the GST in the country and the taxes on many of the inputs that the healthcare industry requires obviates the very reasons why healthcare has been kept out of the GST net, writes Dr Dharmendra Nagar, Managing Director, Paras Healthcare, for Elets News Network (ENN).

Equipment Bad News for Health Industryâ&#x20AC;&#x2122;

onsidering the massive healthcare requirements and the need for healthcare infrastructure in India, the Narendra Modi government has rightly kept the healthcare sector outside of the otherwise overarching Goods and Services Tax (GST) regime.

taxes on many of the inputs that the healthcare industry requires obviates the very reasons why healthcare has been kept out of the GST net. The GST regime has served to increase the cost of several medical equipment used in everyday treatment.

However, the fine print of the roll out of the GST in the country and the

Healthcare Providers Currently Absorbing the Increased Costs

OCTOBER 2017 | ehealth.eletsonline.com

Dr Dharmendra Nagar

Managing Director, Paras Healthcare

The final increase in the prices of a lot of medical equipment is currently being absorbed by the healthcare providers. But in the process, the ability of the healthcare providers to expand to newer geographies

How Higher Taxes on Equipment Ups Cost of Treatment The net effect of the incidence of taxes in current GST system has the potential to make the healthcare cost of a patient go up. For example, now the dialysis treatment for a kidney patient will go up as the equipment required to carry out dialysis has been put in the 12 per cent tax slab when the overall tax incidence on these items was in the region of 5 percent. The hospitals will have to pay 12 per cent tax on dialysis machine, tubings, dialysis needles, catherter, plasma filter, dialysis fluid and the like. The tax on these items was about 5 per cent earlier.

the increase in cost, the hospital has to bear the extra cost which will impact the ability of the healthcare providers to expand and reach out to more and more needy people. It is important to underline here that private players are playing a significant role today in taking basic and tertiary healthcare to a wide number of people, even as government services remain seriously underequipped to meet the healthcare needs of the country. In this scenario, imposing of higher taxes on medical inputs and equipment is a major setback, and doesnâ&#x20AC;&#x2122;t bode well for the healthcare infrastructure in the country. All said and done, private healthcare providers cannot survive and expand services without making suitable profits. Notably, India ranks 154 among 190 countries in terms of healthcare infrastructure, behind even Nepal, Bangladesh and Sri Lanka. If this has to change then healthcare providers need to be given incentives by the government, besides being provided a conducive tax regime.

Considering the fact that about 210,000 people in India suffer from advanced kidney failure every year and require transplants and the fact that only about 6,000-7,000 of them are able to get a kidney from a donor and the only option for the rest of the patients is to go for dialysis on a regular basis, the change in the tax incidence on these dialysis inputs will have a bearing on the cost of the treatment for all such patients. Just to give an example, the cost increase at the patientâ&#x20AC;&#x2122;s end for a dialysis after the change in tax rates is going to be Rs 300 more per session and if a patient requires 10-12 sessions in month, the patient will have to cough up Rs 40,000 extra in a year.

The dialysis equipment and related increase in tax was just an example. There are a host of other medical equipments and inputs that have been made more expensive. The lead valve of pacemaker used in heart treatment will now be taxed at 18 percent from about 5.5 percent earlier. The CRTICD machine will now be taxed at 12 percent, up from 5.5 percent earlier. As a result, the pacemaker which is priced Rs 1.5 lakh will now be costing Rs 15,000-20,000 extra and the ICD will be costing Rs 40,000 extra. If this increase in costs of providing healthcare facilities will not be passed to the end consumer, that is the patient, then healthcare providers will be looking at a bleak future.

Private Players Need Tax Incentives to Expand Services

Zero Rating Needed for All Healthcare Services and Equipment

If the patient has to be insulated from

It is imperative to lay the ground for

zero rating of health and healthcare services to make sure input tax credit is available for refund, in the absence of which healthcare service providers will find it increasingly difficult to provide services at the current rates and prices, and will be compelled to pass on the increased cost to the consumer. Not just healthcare services, there needs to be exemption for all supporting and auxiliary services like cosmetology, dermatology, pathological and even aesthetics and outpatient pharmacy. This is so because unless these costs are controlled, quality healthcare services may not permeate into each and every stratum of the society. Take for example the dearth of quality birthing in India. About 25 percent of all births are still being performed by unprofessional or unskilled midwives, especially in the rural areas and rural pockets of urban centres. At a time when gauze/cotton, gloves and many others have been made expensive under the current GST system, such unskilled personnel are even more unlikely to use proper equipment if there are increases in cost of these consumables. The GST council also has to make sure that there is no ambiguity in polices regarding tax free zones, physician samples, and inter movement of stock transfers. The GST in the country is heralded as a revolutionary step and bodes well for the overall economic environment in the country, something that will not only smoothen operational challenges of businesses but also boost the economical growth in the long run. But in implementing the GST in the country, care has to be taken that it is not contrary to the purpose that was envisaged for introducing it in the first place.

ehealth.eletsonline.com | OCTOBER 2017

INDUSTRY OPINION

and make a difference to the lives of people is being compromised. While initially healthcare providers are bearing the increased costs, there will be a time when they will find it unviable. This is when they will start looking at ways to pass on the increase to the patients, making the cost of treatment more expensive for them.

INDUSTRY PERSPECTIVE

Data Driven

Decisions Stimulating Healthcare Business Healthcare analytics is a fast growing industry worldwide and is expected to have a total addressable market size in excess of $15 billion over the next three years as per various industry estimates. It is at a very nascent stage in India and hence the current market opportunity is probably under $100 million, says Madhu Aravind, CEO, Searchlight Health, a subsidiary of Piramal Group, in an interaction with Rajbala of Elets News Network (ENN).

Madhu Aravind CEO, Searchlight Health, a subsidiary of Piramal Group

What are Searchlight Health’s offerings for hospitals and health insurers?

We are working with the simple premise that healthcare in India can be transformed by data analytics. Examples of these can be the ability for Insurers to launch personalized products to drastically improve access, doctors to see previously unseen patterns in care delivery, pharma companies to understand health drivers and large scale real world usage

OCTOBER 2017 | ehealth.eletsonline.com

information, etc. We believe that by bringing together anonymised patient data, leveraging data that is publicly available and by building best-in-class analytics solutions, healthcare in this country can be more accessible and can create more impact with available resources.

faced in India are fairly different from the West, given the state of maturity of the market. As an example, almost all the data is non-standard, so we had to build the machine learning solutions to convert that into standardized data. Similarly, the models that we needed to solve both the operational and clinical problems also had to be developed from the ground up.

What we have seen is that problems

Since our group companies have been into this business for 20+

Does Searchlight have any proprietary technology or tools?

What is healthcare analytics and how big is the segment in India? What is the total addressable market/business opportunity for Searchlight in India? An estimate would do. Copious amounts of healthcare data is generated daily by various stakeholders in the healthcare ecosystem like hospitals, clinics, pharmaceutical companies, insurance companies, drug stores, diagnosis centres, etc. as part of their business operations. Healthcare analytics refers to the science where this data is scientifically analyzed to create technology solutions that improve clinical outcomes, operational efficiency of these businesses, health care financing, etc. It benefits both the industry as well as consumers. Healthcare analytics is a fast growing industry worldwide and is expected to have a total addressable market size in excess of $15 billion over the next three years as per various industry estimates. It is at a very nascent stage in India and hence the current market opportunity is probably under $100 million. However, with increasing technology adoption and understanding this space too will start growing at a good rate in the years to come.

How difficult it is to persuade hospitals to sign up? How many hospitals have you signed up so far? Initially, it was a challenge to explain our value proposition to hospitals and since this wasn’t tried before, there was no precedence. Gradually, we have been able to demonstrate

the value of our offerings and more importantly the business impact for our partner hospitals and the ensuing patient benefits. We have signed up over 85 hospitals in three cities so far and are aiming to partner 200 hospitals by the end of this year and around 1,000 hospitals by 2020.

What is the feedback to your offerings from health insurers?

We are working on multiple pilot projects with health insurers in India and the feedback has been quite encouraging. We help health insurers create marketleading products by understanding the cost implications of policy specifications scientifically. Our offerings combine nationwide hospital data with powerful modelling tools to help health insurers identify new product and segment opportunities.

Who are your competitors?

The whole health data analytics market itself is in a very nascent stage. In nascent markets, competition is never the challenge. It is only about making progress every day. There are many players -- from IBM to startups -- who are using their own entry points to serve the space.

What is the business/revenue model?

We typically begin our engagement with hospitals by signing them up to the ‘anonymized data sharing’ partnership and offer our standard set of free services for immediate value creation. Based on the evolution of this value that hospitals derive from our analytic services, they sign up for

customized, higher value-added features later which are paid-for.

What is the scope of operations for Searchlight currently? How big is the Searchlight team in India? What is the mid-term and long term strategy for Searchlight? We started our operations two years ago and are headquartered in Bengaluru. We have signed up over 85 hospitals across 3 cities – Bengaluru, Hyderabad and Chennai. We have a team of over 40 currently. By the end of 2017, we aim to partner with 200 hospitals and the goal for 2020 is to partner with 1,000 hospitals.

What is the impact that Searchlight’s offerings can have on the public at large?

Though we are primarily operating in the B2B space currently, our offerings can bring positive impact to end consumers (public) at large in the medium to long term. By helping hospitals improve clinical care delivery and driving efficiency in operations, we indirectly help in improving the standard of healthcare in the country for patients. By helping health insurers identify new product and segment opportunities, we help improve access to health insurance for millions of people who were uninsured earlier.

How much Searchlight plans to invest over the current fiscal to expand its operations?

By virtue of being a subsidiary of Piramal Group, we are not constrained in terms of capital investment when it comes to expanding our operations. We have an aggressive plan to build the business, hire a larger team and partner with more hospitals and health insurers over the current fiscal and beyond.

ehealth.eletsonline.com | OCTOBER 2017

INDUSTRY PERSPECTIVE

years, we were able to leverage the processes, security models etc. but we had to develop the solutions needed in India from scratch.

HEALTH PERSPECTIVE FROM VADODARA

SMART EDUCATION AND HEALTH FOR ANGANWADI CHILDREN Through Early Childhood Care and Education (ECCE), a curriculum of structured materials, quality education is being provided to the children in the pre-primary schools will be implemented at Anganwadi centres of Vadodara, says Devesh M Patel, Chief Medical Officer of Health, Vadodara, in conversation with Elets News Network (ENN).

Devesh M Patel

Chief Medical Officer Vadodara

Give us an outline on early childhood care and education initiatives being implemented in the Anganwadi centres? The Government of Gujarat in collaboration with UNICEF has included Anganwadis of Vadodara in its project â&#x20AC;&#x153;Early Childhood Care and Education (ECCE)â&#x20AC;?. Through ECCE, a curriculum of structured materials, a quality education being provided to the children in the pre-primary schools will also be implemented at the centres. The Vadodara Municipal Corporation (VMC) is in the process of installing television and computer sets including other infrastructure

OCTOBER 2017 | ehealth.eletsonline.com

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CHHATTISGARH 24-25 October 2017, 2017 Raipur December,

Redefining Chhattisgarh Healthcare Spectrum with Conducive Policies... Elets Technomedia, Asia & Middle East’s premier media & technology research organization is organizing ‘Healthcare Summit- Chhattisgarh’ to bring stakeholders together from government & industry aiming to build a roadmap to bring transformational change in state’s health care ecosystem.

Dr Raman Singh Hon’ble Chief Minister of Chhattisgarh PROGRAMME CHAIR SHRI R PRASANA Commissioner Department of Health & Family Welfare and Mission Director, National Health Mission Government of Chhattisgarh

Join this Extraordinary Platform that will Host Thought Leaders, Policy Makers, Top Industry Leaders, Academia and Other Industry Stakeholders from the Healthcare Sector.

Special Attraction of ‘Elets Healthcare Summit –Chhattisgarh’ • Roundtable of Industry Leaders with Dr Raman Singh, Hon’ble Chief Minister, Chhattisgarh & Shri Ajay Chandrakar, Hon’ble Minister of Health & Family Welfare, Chhattisgarh • Hospitals, Pharmaceutical Companies, Medical Devices Manufacturers to showcase their products and services directly to Chhattisgarh Medical Services Corporation Limited (CGMSCL) -- the state government’s procurement agency • Platform for healthcare stakeholders to interface with policy makers, industry leaders and experts

Shri Ajay Chandrakar Hon’ble Minister of Health & Family Welfare, Government of Chhattisgarh

Key Themes: • Roping in private and not for profit sector to ensure availability of affordable healthcare in Chhattisgarh • Using Health Insurance to reduce out-of-pocket expenditure of citizens on quality healthcare • Future scope of resource mobilisation – private sector investment, pooling of resources • Designing world-class hospitals • Role of technology like telemedicine to ensure affordable healthcare in naxalite affected areas of the state • Health system strengthening and reforms • Using IT for transformation of healthcare • Improving quality of healthcare at hospitals • Ensuring availability of quality human resources in Chhattisgarh • Strategies to reduce the burden of communicable as well as non-communicable diseases

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For Programme Queries: Gopi Krishna Arora, gopi@elets.co.in, +91-9582892293

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HEALTH PERSPECTIVE FROM VADODARA

WE HAVE A MOBILE APPLICATION CALLED “SMART ANGANWADI” TO TRACK THE PROGRESS AND DAY’S DUTIES OF ANGANWADI WORKERS. ACTIVITIES RELATED TO DELIVERY AND CONSUMPTION OF MILK, FRUIT AND SWEETS, PROGRESS OF KIDS ON MONTHLY BASIS (WEIGHT AND HEIGHT), ETC, ARE REGULARLY MONITORED THROUGH THIS APP. required for the full functioning of the project at the centres. The curriculum has been designed in the form of animations and audiovisuals, to help children enhance their cognitive learning. The motive of the move is to make Anganwadi children competent enough for taking classes at schools.

When will the ECCE project kickstart at Anganwadi centres? What kind of initiatives will be taken to train Anganwadi teachers with the latest technology? The project will be facilitated at about 350 centres, and will gradually cover all 400 centres. Our Anganwadi workers are already trained by UNICEF. However, in order to make them apt with the curriculum, the team who has designed the animation with the help of audiovisual materials will also train them.

What is the student strength of Anganwadi centres in Vadodara? What subjects will be covered as part of the curriculum?

OCTOBER 2017 | ehealth.eletsonline.com

The registered children in the Anganwadi centres between the age of 0-6 years old is around 60,000, of which 35,000 children fall under the age group of 3-6 years. The curriculum will cover the children of the latter group of age. It will cover all subjects which are being taught at the private pre-primary schools, i.e., alphabets, numbers, stories, etc. The module has been prepared in such a manner so that it can be imparted on a daily basis. For instance, everyday the classes will resume with a prayer and everyday, different topics will be taught. Also, tests and backup sessions will be conducted, similar to what is being followed at any private pre-primary school.

Give a brief account on the economic and education background of the children in Anganwadi of Vadodara. Anganwadis in Vadodara are mostly centered in the slum or slum-like areas. The parents of these children earn less than Rs 5,000 to Rs 10,000 per month. For these children, we

have nutrition, healthcare and other programmes associated for their benefit. However, a proper educational pattern was missing. Hence, by introducing a curriculum through the ECCE, education will receive a major boost in line with what other preprimary school children are getting.

Vadodara Municipal Corporation has also launched a mobilebased application of Anganwadi workers. Kindly explain. We have a mobile application called “Smart Anganwadi” to track the progress and day’s duties of Anganwadi workers. Activities related to delivery and consumption of milk, fruit and sweets, progress of kids on monthly basis (weight and height), etc, are regularly monitored through this app. Every Anganwadi worker through their smartphone, update their daily duties so that we can monitor the functioning of the whole system.

FEATURE

Lung Transplantation Another Glorious Chapter For PGIMER, Chandigarh

Chandigarh, also viewed by many as an ‘Island of Excellence”, has been applauded for many ‘first of kind’ procedures in the past. Yet, even for one of its prestigious medical institutes a new glorious chapter has been added to its book of laurels recently, writes Priya Yadav of Elets News Network (ENN).

t’s a moment of glory for the prestigious Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, as the institute recently became the first government hospital in the country to have successfully conducted one of the most complicated organ transplants -- lung transplant. The procedure, conducted in July, has once again proved the mettle, expertise and high level of dedication of the doctors and the paramedics at the government hospital. PGIMER has already been running programmes for liver, heart, kidney, bone marrow and cornea transplant. The lung transplant is another feather in its cap now. Transplant of pancreas and the intestine is on the cards now. The institute takes pride in the fact that the transplant surgery centre is one of the pioneers in transplantation in India. The first renal transplant was performed 44 years ago, in June 1973. Today, it is still one of the largest centres providing composite facilities for renal transplantation in the country.

OCTOBER 2017 | ehealth.eletsonline.com

What makes the institute so special is the subsidised rates at which the most complex and challenging of procedures, requiring state of the art equipment and world class expertise, are done. A renal transplant in a private sector costs over Rs 20 lakhs where at PGI the cost is barely Rs 70,000. Similarly, the lung transplant that would cost Rs 45 lakhs in a private sector is done at just Rs 10 lakhs. The first one was done absolutely free of cost.

The donor for the first lung transplant was a 22-year-old young man, Bhola Singh, from a village in Punjab who suffered severe head injuries after his scooter was hit by a speeding vehicle. After he was declared brain dead, the transplant coordinator at the institute convinced the family to donate organs to which the latter finally agreed. A team of over 20 surgeons and paramedics spent over 12 hours in the operation theatre wherein

The recipient is a 34-year-old woman (name withheld) from Sangrur. For her, what started off as a bad cough led to breathlessness and the condition rapidly deteriorated. When she was brought to PGI she was told that 95% of her lungs were completely damaged and that she had to be on an oxygen machine all the time. Or, she could be saved if there was a donor. As soon as Bhola Singh’s family gave consent to donate his organs, the PGI made a call to the recipient and she was admitted to the hospital for the transplant. Commenting on the success of the surgery, Director PGI, Professor Jagat Ram, said, “Though cadaver donor organ transplants have picked up across the country, lung transplants are still quite uncommon. This is partly because the surgery is complex and technically demanding and also because there are not too many usable lungs. PGI not only surpasses the 27 number of cadaver organ donations of last year but also has to its credit the first in public sector hospitals in lung transplant surgery in India.”

The approval for the transplant was given to the institute in 2013. “Due to non-availability of a perfect matching donor-recipient, we had been waiting to perform this transplant since long,” said Dr Rana Sandeep Singh, a cardiovascular and thoracic surgeon, PGI. Dr Vipin Kaushal, the nodal officer for Regional Organ & Tissue Transplant Organisation, PGI said, “We are also doing cadaveric transplantation depending upon the availability of the cadavers and we maintain a list of patients who need organs. We are proud to say that our success rate in transplants is among the best in the country.” Renal transplants, which began over forty years ago, are still the most popular at the Institute. The department of Nephrology has a six bedded ICU which was upgraded to twelve beds recently and has a separate Operation theatre complex dedicated to transplant and related surgery and has state of the art equipments for managing patients in the intra-op and post-op period. “The department has experience of performing more than 1,500 living as well as cadaver donor renal transplants

so far and has performed renal transplants in a number of complex situations. In addition to this, it is also involved in various vascular access procedures for Haemodialysis and has been performing major vascular surgery procedures,” he said. The department introduced advanced laparoscopic methods for retrieval of donor kidneys in 2004 and is currently performing laparoscopic donor nephrectomy in all donors. INSET The organ transplant team in PGI is one of the most proactive across the country. No one understands and appreciates the true value of donation of an organ more than this team. That is why, in March this year, when they got organs donated, heart and liver, that did not match any of their own patients, they alerted the National Organ & Tissue Transplant Organisation (NOTTO). A team of 30 specialised doctors worked over a period of 72 hours of uncertainty while the government worked to provide four green corridors in two cities and two planes to airlift of the heart and liver of a 40-year-old brain-dead patient from Chandigarh to Delhi on Monday (August 21). It gave a new lease of life to four people in three hospitals — PGIMER in Chandigarh, AIIMS in Delhi and Medanta Hospital in Gurgaon. It maybe noted that in a bid to speed up the transportation of the organs to the airport, the first green corridor was created with the help of the UT Police in Chandigarh, ensuring that the ambulance reached the airport in a span of 20 minutes. The chartered flight departed at 7.55 am for Delhi and with the help of green corridor in Delhi, it reached Gurgaon.

ehealth.eletsonline.com | OCTOBER 2017

FEATURE

they retrieved six organs and saved four lives. Apart from this, two were given vision.

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Technological advances have made today’s medical world grow by leaps and bounds. It has made surgeons operate with more precision and safety, help physicians make more accurate diagnoses and obstetricians deliver healthier babies, writes Dr Sameer Pagad, Consultant Cardiologist, K J Somaiya Hospital Superspeciality Centre, for Elets News Network (ENN).

Dr Sameer Pagad

Consultant Cardiologist, K J Somaiya Hospital Superspeciality Centre

n my line of work, interventional cardiology; necessity has truly been the mother of intervention. Few other fields in medicine have made such quick progress as interventional cardiology.

Stents when they were introduced around a couple of decades ago were nothing but a metal mesh which helped maintain the patency of the vessel. Such rapid progress has been made with the advancements in technology that today we really have the state of the art stuff, thinner struts, drug elution, biodegradable polymer, to totally biodegradable stents. The devices used to deliver stents safely have been constantly being upgraded and today we have much superior devices like rotablation (a burr with diamond chips embedded on the top which helps in chiselling our way through tough calcific lesions), cutting balloons (balloon with blades embedded on it which again helps give controlled cuts precisely to soften a tough lesion) and

so on. And, all this is being done in an artery about 3 millimetre in diameter! If not for the technical advances, all this was impossible. All these devices help the procedure of angioplasty to be safer and results to be more rewarding. Another device, which never fails to fascinate me, is the pacemaker. I am yet to see a more intelligent device in the medical world. Not only does it regulate and drive the electrical impulse needed to generate a contraction in people with diseased electrical circuits of the heart; in todays’ devices it can detect faulty rhythms, correct them, give a shock if required, detect fluid accumulation in the lungs, synchronise the way the heart contracts, keep a track and record of every heartbeat since its implantation. And all this happens when the size keeps decreasing with every up gradation. It is interesting to note that the first pacemaker implanted

in humans, had the patient to be connected to the huge pacemaker externally and the patient had to literally wheel it with him! Now they are the size of a matchbox, implanted under the skin done in local anaesthesia! Today, thanks to the technology, we are mimicking all what the surgeon does in an open heart surgery;percutaneously (via small punctures in the groin). Trans cutaneous aortic valve replacements (TAVR), Mitraclip (device which corrects a leaking valve), Watchman device (device which plugs a small chamber in the heart and prevents clot formation) all can be done percutaneously, thus decreasing patient morbidity significantly but with equal efficacy as an open heart surgery. Such is the pace at which advancements in medical technologies are being made, it keeps us doctors continuously on our toes to keep abreast of the very latest, in our eternal quest of giving the best to our patients.

ehealth.eletsonline.com | OCTOBER 2017

INDUSTRY PERSPECTIVE

‘TECHNOLOGY MAKING A DIFFERENCE IN TODAY’S MEDICAL WORLD’

POLICY MAKERâ&#x20AC;&#x2122;S PERSPECTIVE

ENSURING EASE OF DOING BUSINESS IN HIMACHAL Mandated to ensure effective implementation and monitoring of various Acts applicable to the health sector in Himachal Pradesh like Environment (Protection) Act, the Mental Health Act, Drugs and Cosmetic Act, management of bio-medical waste, human organ transplantation, etc, the Directorate of Health Safety and Regulation, Government of Himachal Pradesh has taken various initiatives in the area of ease of doing business, says its Director Captain (Retired) Raman Kumar Sharma in an interview with Rajbala of Elets News Network (ENN).

Raman Kumar

Sharma

Director, Health Safety and Regulation, Government of Himachal Pradesh

How the Directorate of Health Safety and Regulation ensures effective implementation and monitoring of various Acts applicable to the health sector in Himachal Pradesh? The Directorate of Health Safety and Regulations ensures effective implementation and monitoring of various Acts through its enforcement staff. As far as enforcing the Drugs and Cosmetics Act is concerned, there are drug inspectors, assistant drug controllers and the state drugs controller who effectively implement the various provisions of the Act. The Directorate also provides grants and renewal of licenses, drawing

OCTOBER 2017 | ehealth.eletsonline.com

samples and inspection of sales and manufacturing units across the State. The Directorate of Health Safety and

Regulation has structured the process of regulating various grants related to manufacturing, wholesale and retail drug licenses, pharmacy licenses,

etc. The Directorate closely monitors and provides adequate arrangement for the prescribed storage of drugs in order to maintain potency during the period of shelf-life of the drugs.

What is the procedure and timeline for providing grants and renewal of drug manufacturing in the State? The timeline for grants and renewal of Drugs manufacturing licenses in the State is 21 days after the submission of online application on portal to the final dispense of an approval certificate. After the application for grants or renewal of licenses is received by the licensing authority, documents are scrutinised and the drug inspector is asked to conduct the physical inspection of the proposed premises. The drug inspector inspects the premises and submits a report to the licensing authority, which further grants/renews/rejects the license as per the report.

What initiatives or strategies have been adopted to promote ease of doing business in the healthcare sector? Under the ease of doing business initiative, online receiving and

disposal of applications are helping to create good business environment in the healthcare sector. Our State is under the process of accepting manufacturing applications online and their disposal will be through software only. This proposal is in the pipeline.

Baddi has become a major manufacturing hub for Indian and multinational pharma companies. Do you have any other such project to promote pharma manufacturing in Himachal Pradesh? Baddi has become one of the major manufacturing hub for pharmaceutical companies in the State. Many R&D plants, pharmaceutical productions – mainly formulations – have been established there. We are in discussions to expand pharma manufacturing industry in other parts of the State as well. Other than Baddi, there are places like Solan, Parwanoo, Tahliwal, Kala Amb, Paonta Sahib and Sansarpur Terrace where manufacturers have shown interest to set-up pharmaceutical units. In addition to that, a world-class laboratory for testing of drugs will be established at Baddi in coming years.

Tell us about e-health initiatives and various government schemes implemented by the State.

Online, or we can say technology presence, has brought transparency in the functioning of internal system and facilitated close monitoring by the management and authorities to achieve uniformity and standardisation in the procedures and processes of manufacturing, issuing of pharma licenses, wholesale retail licenses, etc. In terms of online initiatives, the grants or renewal of sales licenses has already been made online. Under our e-health initiative, the manufacturing licenses will be online very shortly. This facility will help companies in obtaining licenses or renewals in shortest span of time. We look forward to implement user-friendly application modules to increase efficiency in the industry of the State in near future.

ehealth.eletsonline.com | OCTOBER 2017

POLICY MAKER’S PERSPECTIVE

THE TIMELINE FOR GRANTS AND RENEWAL OF DRUGS MANUFACTURING LICENSES IN THE STATE IS 21 DAYS AFTER THE SUBMISSION OF ONLINE APPLICATION ON PORTAL TO THE FINAL DISPENSE OF AN APPROVAL CERTIFICATE.

FEATURE

PPP: A POTENT TOOL TO

Achieve Excellence in Healthcare

ublic-private partnerships (PPP) are increasingly seen as playing a critical role in improving the performance of health systems worldwide by bringing together the best characteristics of the public and private sectors to improve efficiency, quality, innovation, and health impact of both private and public systems.

OCTOBER 2017 | ehealth.eletsonline.com

While partnerships can be an effective force toward achieving these results, they are not a complete solution to the many problems that now face health systems. If partnerships are to be effective in addressing the issues of poverty reduction and equity, quality improvement, and cost containment, considerable work will need to be done to develop the accountability and

Karnataka has made tremendous gains in the delivery of healthcare to the majority of its population. However, access to health care is only of value if the care is of high quality. It is in this regard that the publicprivate partnership has emerged as an effective tool, writes T Radha Krishna of Elets News Network (ENN).

transparency, the legal and regulatory framework, and the mutual trust that is necessary for partnerships to succeed. In today’s scenario of complexity and rapid pace it is almost impossible to do anything alone. This is especially true in health where constantly rising prices, changing disease patterns, and increasing use of sophisticated technology for diagnosis and treatment have made it virtually impossible to imagine any single organization providing services without some type of institutional partnership. The partners, too, may vary from private— for—profit companies, not—for— profit organizations, Governments, donor organizations, to community groups. Partnerships may vary in terms

However, financial gain is not the only benefit of partnership, and in many cases of partnership, other considerations provide the incentive. A common one is the transfer of technical knowledge between partners. This is often the case in partnerships between the public sector and NGOs, where both partners have knowledge and skills that is useful to the other are able to learn from each other Karnataka has made tremendous gains in the delivery of health care to the majority of its population. Today, most people have access to health care. However, access to health care is only of value if the care is of high quality. This has been more difficult to achieve, and is one of the hopes for partnerships. In order to provide quality health care and to operate, manage and redevelop the existing Government Mother & Child Hospital complex which is spread over three plots of land in Udupi town, KM Marg Road as well as development of a centre of excellence hospital and preventive and community health facility in this premises, the philosophy of publicprivate partnership was thought of. There was a 70 bedded government mother and child hospital, which building was in a very dilapidated condition. The average outpatient per day in this hospital is around 150 and the average inpatient per day is around 100. The existing place had become acutely insufficient to meet the current demand. Since it is a government hospital, it invariably needs to cater to all sections of the society who come

for relief. However, the institution was not in a position to respond to the aspirations and the needs of local population. Under the said circumstances a proposal was submitted to the department by a philanthropist, expressing his interest and commitment to construct a 200 bedded mother and child hospital, which thereby enhances the bed strength from 70 to 200. He had also expressed 100 per cent free service to all the health assurance beneficiaries. He had further made it clear that the entire cost of construction of this structure would be borne by the service provider, besides the required quarters for doctors and allied staff along with hospital structure. It is also represented that the entire management of the hospital such as the wages to the working staff and supply of medicines was also offered to be taken care by the service provider. The service provider (BRS Enterprises) run by an NRI, who originally belonged to Udupi town and did this work in memory of his late father, had suggested that the Institution be named after his beloved father and the department felt that the said proposal looked credible and it could be appropriate to re-name the hospital. The proposal to put up 400 bedded centre of excellence hospital in the same locality on the land that belongs to the said mother and child hospital was also examined which is spread over three plots of land in Udupi town measuring 3.88 acres and leased the land for the project for a minimum period of 30 years . For patient seeking emergency treatment, the services for any mother and child hospital is proposed to be completely free of cost in centre of excellence hospital. Besides this

KARNATAKA HAS MADE TREMENDOUS GAINS IN THE DELIVERY OF HEALTH CARE TO THE MAJORITY OF ITS POPULATION. TODAY, MOST PEOPLE HAVE ACCESS TO HEALTH CARE. HOWEVER, ACCESS TO HEALTH CARE IS ONLY OF VALUE IF THE CARE IS OF HIGH QUALITY. THIS HAS BEEN MORE DIFFICULT TO ACHIEVE, AND IS ONE OF THE HOPES FOR PARTNERSHIPS.

various groups of people covered under different Government Schemes will have the priority as per guidelines of Government of Karnataka. This hospital is proposed to offer free medical care to mother and child patients residing in Udupi district. It is also proposed to set up residential quarters for staff accommodation on the said plot. The proposed hospital offers specialised and super-specialised medical services free of cost to Memorial Hospital patients and to other BPL families and proposed to provide services as per government schemes to health assurance beneficiaries. The pricing for other patients it intended to be transparent and ethical. A preventive and community health facility also proposed in the hospital complex.

ehealth.eletsonline.com | OCTOBER 2017

FEATURE

of financing of crores of Rupees to the sharing of non-financial resources. However, all partnerships have one thing in common: they have come about because both partners believe they have something to gain from the partnership agreement.

CONFERENCE REPORT

UNLOCKING INDIA’S POTENTIAL IN FOOD & PHARMA SECTORS The Pharmaceutical and Food sectors are the bellwether sectors of the Indian economy, holding immense potential of growth. However, this growth will entirely depend on the industry’s effort to implement initiatives that are innovative in nature to help transform these sectors and achieve their full growth potential. To address the various challenges faced by the Food and Pharma sectors in India and outline the future roadmap to ensure their uninhibited growth, Elets Technomedia in association with Food and Drug Administration, Gujarat, organised the first National Food and Pharma Summit in Ahmedabad on August 28. The summit was graced by who’s who of the food and pharmaceutical industry. The summit offered a unique platform for all the stakeholders of food and pharma industry to come together to discuss technological innovations and various issues at hand. The deliberations and discussions at the summit underscored the need for adopting innovative means to help India become a leader in these industrial segments, even as experts admitted that despite delivering high volumes of food and pharma products to the world a lot needs to be done in terms of quality improvement in order to claim a bigger pie of the global market. Apart from highlighting the most pressing issues concerning the food and pharma sectors, the summit also acknowledged the exemplary work being done by food business operators and pharma companies by honouring them with awards in various categories. The National Food and Pharma Summit was organised in Gujarat owing to the state’s leadership position in terms of ease of doing business, coupled with various e-Governance initiatives that have brought in transparency in regulatory processes. Backed by a favourable business environment, the state has emerged as the food and pharma capital of India and is all set to roll out more policies to help India achieve its economic goals and serve as a role model for other states. Here is a glimpse of the grand summit...

OCTOBER 2017 | ehealth.eletsonline.com

CONFERENCE REPORT

Punamchand Parmar

Additional Chief Secretary, Health and Family Welfare Department, Government of Gujarat The population in India and across the world is growing rapidly. We have crossed the 7 billion mark and may cross the 8 billion mark in near future. Our life expectancy at the time when pyramids were built in Egypt was around 40 years and also when we became an independent nation our life expectancy was very low. But now as the life expectancy in the world is reaching 75-80 years, India is also reaching that level. But as the life expectancy is increasing the number of diseases is also increasing. Food and pharma go together. In ancient times, food was our pharma. Indian kitchens were at the centre of this because of the food ingredients we use. For example, black pepper we use in our food is a very good anti-oxident and improves our immunity. British came to India in search of this spice. In the name of leading a good quality life, we have changed our food habits and by changing the taste of our tongue we are spoiling our health. As a result the kitchen, which acted as a very powerful healthcare centre at the home, has been disturbed and it has been replaced by pharma products. Still, they both are our friends.”

Dr Hemant G Koshia

Commissioner, Food and Drug Control Administration, Government of Gujarat Gujarat is known for its pharmaceutical industry. The state is the ‘Pharma Capital of the Nation’. There are more than 4,000 licensed pharma manufacturers and around 37,000 retail pharmacies in Gujarat. It is also the hub of the food processing industry of the country. We have around 2.5 lakh food business operators in the state. Gujarat is known for ease of doing business. We have done a series of biannual events like Vibrant Gujarat and Global Investors Summit. Through these events, the Government of Gujarat is promoting different segments and inviting investors to do business here. Gujarat is a very fertile land from business perspective. As a regulator and as part of the government it is our duty to ensure the citizens get safe food and pharmaceuticals through implementation of the Food Regulatory Act in Gujarat. For the food sector, we have the Food Standards Act, and for the pharma sector, we have the Drugs and Cosmetics Act. We work in very close collaboration with industry regulators like USFDA, MHRA of UK. A lot of medicines being manufactured in Gujarat are exported. One-third of the national production of drugs happens in Gujarat and almost 28 per cent of the pharma products are exported to about 175 countries around the world. Gujarat has 109 years of legacy in producing drugs. The state is the largest producer of antibiotic drug Ethambutol and the world’s 70 per cent of Isoniazid is produced in Gujarat. The state is an emerging hub for medical devices manufacturing as well. It is a leading producer of cardiac stents and implants. The country’s 50 per cent of orthopediciol intraocular lenses are produced here. Both food and pharma are the technology driven industry. Both are innovative industries. There is a lot of science involved in the day-to-day running of these industries.”

ehealth.eletsonline.com | OCTOBER 2017

CONFERENCE REPORT

V R Shah

Deputy Commissioner, Food & Drugs Control Administration, Government of Gujarat

There are more people alive today than have ever died. There are 7 billion people living on earth and we are growing rapidly. What it means is that today there are more opportunities for everyone to grow. All the 7 billion people need food, shelter and healthcare. This implies that the demand is going to multiply. Governments across the globe are making serious effort to increase the life expectancy and the quality of life index for their citizens. There is probably not a single country that doesn’t import pharmaceuticals from India. The growth of Indian pharma industry has always been a shade better than the country’s GDP. We have attained almost 1.5 times the growth of GDP. If we look at the pharma industry, during the last decade it has made a three-fold increase with a CAGR of 17.5 per cent. Currently, the Indian pharma industry is valued at $36.5 billion and is expected to reach $55 billion by 2020. This shift has come with its own set of challenges as well as opportunities. We cannot continue to grow tomorrow with yesterday’s policies, perspectives and the ways of doing business. Therefore, we need a stable industry-friendly policy and environment to foster growth. The Government of India has recently come up with a draft national pharma policy, which is likely to address a lot of issues.”

Speakers at the inaugural session of the National Food & Pharma Summit, Gujarat.

OCTOBER 2017 | ehealth.eletsonline.com

CONFERENCE REPORT

The National Food and Pharma Summit is a good initiative for the food industry. We have a lot of summits for pharma. But for the food industry, it’s the first summit organised in Gujarat. People have come to know what kind of technology we can employ to make the food products safe. I am taking a wonderful message from this summit that the food should have a good taste as well as it should be safe. For that, technology needs to be implemented by the manufacturers to offer good quality of food to the consumers.”

Geoff Wain

British Deputy High Commissioner We are proud to be the first country to have full diplomatic representation in this state. This is right because Gujarat is very important to the UK. It is important to us politically and economically. There are 700,000 people of Gujarati-origin in the UK and, therefore, Gujarat is important for us culturally and socially as well.

Dipika Chouhan

Deputy Commissioner (Food), Food and Drug Control Administration, Government of Gujarat

We opened our office in Gujarat in 2015 and last year we opened a new British Council Cultural Centre. Earlier, we opened a bigger Visa application centre in Ahmadabad. We are making very practical investments into the state because of the special relationship we have with Gujarat and Gujratis. The UK now has 10 offices across India. We employ around 1,000 people in India. We have more staff, we have more offices in India than in any other single country anywhere in the world. Talking about UK’s life sciences sector and the opportunities to do business with the country, he said, about 7 of the top 100 medicines in use today around the world originated from the research in the UK. We currently have 79 Nobel Prizes for contributions to medical sciences and all of the 20 biggest pharmaceutical manufacturing companies in the world are active and represented in the UK. The life sciences sector is the third largest contributor to the economic growth in the UK, accounting for 200,000 jobs with a total turnover of $59 billion. More than three million patients have been recruited for clinical research in the UK. UK and India have been working together for a very long time to develop novel drugs and innovative product manufacturing processes. The British government is currently running a campaign for developing tomorrow’s medicines, which will make the best medicine in quality. We strongly support the ‘Make in India’ campaign of Prime Minister Modi ji. To deepen and strengthen the IndiaUK relationship, the UK government is promoting Make in India using the UK technology. We have some excellent success stories of Indian companies collaborating with UK companies in areas of diabetes treatment, oncology, antimicrobial resistance and vaccines.”

ehealth.eletsonline.com | OCTOBER 2017

CONFERENCE REPORT

Food and drugs industry is extremely important for the country. For example, in terms of maternal mortality rate, Gujarat is among the top 10 states in India. But we must aim to achieve a mortality rate of less than 10, which is the rate in Scandinavian countries. To reach that level, food and drug industry will play a major role. The infant mortality rate in Gujarat is 33. We must aim for less than 10. It is already there in Sustainable Development Goals. We are also facing a huge disease burden of tuberculosis, noncommunicable and communicable diseases. In controlling the lifestyle linked disorder, the food and pharma industry has a big role to play. Especially, the food quality needs to be checked. Gastrointestinal diseases like acute diarrheal diseases, cholera, typhoid, bacillary dysentery and Hapatitis A and E are directly linked to the food industry. In anti-tubercular therapy, the treatment takes too long. The pharma industry can do a lot in making the duration of treatment shorter for a person suffering from multi-drug resistant tuberculosis. There are many diseases like influenza and swine flu. We can new inventions and R&D has to be promoted because virus changes with time. For example, in influenza virus there is antigenic drift and antigenic shift. If the genotype of the virus changes slightly then there is antigenic drift and if the genotype of the virus changes totally then there is antigenic shift. So, the virus is changing constantly and the anti-viral drug that is affecting the virus has to change accordingly. Likewise, to fight against microbial organisms like bacteria, virus, protozoa these need to be monitored by the pharma industry with the support of R&D.â&#x20AC;?

Dr Gaurav Dahiya

Mission Director, National Health Mission, Government of Gujarat

OCTOBER 2017 | ehealth.eletsonline.com

Dr Pallavi Darade

Commissioner, Food and Drug Administration, Government of Maharashtra The pharmaceutical industry in India is robust and thriving. The annual turnover of the industry in 2015-16 was about 200,000 crores and the exports were worth about 11 lakh crores. The domestic consumption was around 98,000 crores. The Indian pharma sector is largely fuelled by exports and is the third largest foreign exchange earner for India. It employs about 200,000 work force across the value chain. It is a private investment driven industry and the contribution of the Public Sector Undertakings is literally negligible. Indian pharma industry has the largest number of USFDA approved manufacturing facilities outside the US. Also, the plans approved under the EDQM, WHO and GMP. I think the major concerns that are worrying the industry today is decline in the CAGR, non-adherence to quality standard norms, the growing competition from other countries, huge dependence on imports for the key starting materials as also the APIs, lack of R&D and discovery of new molecules. For all the other things, the policy matters. But adherence to quality and standards is concerning the regulatory authorities. The pharma industry in Maharashtra constitutes almost one-third of Indiaâ&#x20AC;&#x2122;s production. Till 2005, Maharashtra was the leading state in the field of pharmaceutical manufacturing and had however because of the creation of special economic zones lost its edge in some parts but has little effect on the growth of the industry in the state. Maharashtra FDA nearly has about 18,000 crores of export industry. To further strengthen the base, it is essential to maintain quality standards of drugs and upgrade the regulatory norms. The pharma policy by the Government of India has already initiated such steps...The Schedule M of Drug and Cosmetics Rule 1945 was substituted completely by a revised Schedule M under GSR in 2001. Taking this forward, Maharashtra has made it compulsory to fill the Schedule M and submit it to the authorities. The Schedule M defines in detail the general requirements, the water system, the disposal of waste, the warehousing area, the ancillary area, the quality control area, health, clothing and sanitation of workers, etc.â&#x20AC;?

CONFERENCE REPORT

Our State is ‘Vibrant Gujarat’. Gujarat is vibrant because of infrastructure facilities and the locational advantage of Gujarat. So, every Gujarati is always thinking about entrepreneurship and has entrepreneurship skills. Therefore, we are the growth engine of India. Having 6 per cent of India’s geographical area and five per cent of the country’s population, Gujarat contributes 7.6 per cent to India’s GDP. Gujarat has 10 per cent of India’s factories, yet we contribute 18 per cent to India’s industrial output and more than 20 per cent to India’s exports. For FDI, we were the third largest recipient in India in 2016-17. Gujarat is the top state for green field projects. We are handling 41 per cent of India’s export cargo through our ports. Gujarat also has the world’s largest refinery in Jamnagar, and is the world’s largest producer of castor, cumin, fanal seeds, etc. We are the world’s largest producer of processed diamonds. We have the world’s largest fully-mechanised gold terminal. In the area of infrastructure, Gujarat has the road connectivity of around 80-90 per cent up to the level of villages. We have 1,63,153 kms of well connected surface roads in Gujarat. Our rail length is also 5,259 kms and we are going to start metro rail projects in Ahmadabad, Gandhi Nagar and Surat. Gujarat has 17 operational airports, including air strips. We have two international airports -- one in Ahmadabad and another in Vadodara. We have 47 ports, including KPT Kandala port which is one of the major ports in the country. Gujarat is a power surplus state, proving 24/7 power supply to all in the state. Our conventional power producing capacity is 20 MW. We also have a 1,20,769 kms long drinking water supply grid that aims to serve 75 per cent of Gujarat’s population.”

O P Sadhwani

Joint Commissioner, Food and Drug Administration, Government of Maharashtra

There are two major initiatives that we have taken. The first one is that the manufacturing industry should follow good compliance practices. So, we have initiated self-compliance practice in the industries. For that, we have prepared a selfcompliance check list. All the dealers and manufacturers will be self-auditing themselves and sending the reports to their licensing authorities. Secondly, we have gone online for manufacturing, selling licenses. The process is totally paperless with the provision of e-sign. The Aadhaar-based third-party verification is also available online and the dealer needs not come to our office for licensing at all. One can apply online, the papers can be uploaded online, and after looking into them and doing inspection wherever it is necessary, the manufacturer or dealer can avail the licenses online. This will save millions of papers and the records have been digitised. This will facilitate fast retrieval of data.”

H D Shrimali

Additional Industries Commissioner Government of Gujarat

ehealth.eletsonline.com | OCTOBER 2017

CONFERENCE REPORT

Technology is going to play a very important role in the food and pharma sector, as well as for the regulatory authority in various ways, for example, enabling the food business operators to meet the standards that have been laid down, using technology for preparation and packaging of safe food material and also disseminating information among the consumers. As far as regulatory authorities are concerned, technology can be used for smoothening processes. The Food Safety Authority of India has come up with a solution where the inspections can be done online on real-time basis, which will bring in a lot of transparency. Already the online registration and licensing is in progress, which is being further improved. At the same time, addressing the issues faced by the consumers can be addressed. Also, we can resolve the training needs of the food safety personnel, upgrading their skills and employing technology in imparting online courses and other training to the food business operators.â&#x20AC;?

Hrushikesh Mohapatra

Drug Controller, Directorate of Drugs Control Administration, Government of Odisha The interactions between food industry people and pharma sector people and their deliberations have helped us to improve ourselves and attract food and pharma businesses towards Odisha. Odhisha is a small state and has a large consumer base in pharma. But we have very less pharma units in Odisha. Our expectation from the National Food and Pharma Summit Gujarat is that here we can find companies that can come and invest in Odisha. We have a favourable pharma and industrial policy. We have given many incentives to our industries. In the area of ease of doing business, the Drug Control Administration in Odisha has introduced 2-3 software which will be functional in 1-2 months. We already have tested and made online another software, and we hope that all these e-governance initiatives will attract the industries to come to Odisha.â&#x20AC;?

Ravindra Pratap Singh

Food Safety Commissioner, Health and Family Welfare Department, Government of Odisha

An attentive audience listening to the speakers at the National Food & Pharma Summit, Gujarat.

OCTOBER 2017 | ehealth.eletsonline.com

CONFERENCE REPORT

Most of us are aware that Food Safety Standards Act was passed in 2006 and implemented in 2011. Earlier, there were PFA and multiple other Acts governed by various government agencies and departments for different food products. With the implementation of Food Safety Standards Act, all food products were brought under the purview of this act. The Food Safety Standards Authority of India (FSSAI) was established for laying down science based standards for all food items, wherein the manufacture, distribution, sale and import of all food products is regulated by this act. The major objective of FSSAI is to ensure that safe and wholesome food is available for human consumption. In the last 5-6 years, FSSAI has framed many regulations and it is an evolving process. FSSAI is working with food businesses to come up with new regulations. Wherever there is no national standard, we are adopting standards from CODEX. We have simplified food registration and licensing system. Till now we have 30,000 central licenses, over three lakh state licenses and over 24 lakh registrations of food businesses.”

Prof Kiran Kalia

Director, National Institute of Pharmaceutical Education & Research, Ahmedabad

Academia is an integral part of the industry because academic institutions are the one which give talented, skilled human resource – a very essential part of growth and development of any organisation. NIPER Mohali was set up long time back. But to support the industrial growth of pharmaceutical industry, the Government of India in 2007 initiated setting up of six new NIPERs in Ahmedabad, Hyderabad, Kolkata, Guahati, Rae Bareilly and Hajipur.

Dr Sheetal Gupta

Senior Scientist CFTRI/ DO cum CLO, Food Safety and Standards Authority of India (FSSAI), Maharashtra

NIPER Ahmedabad was fortunate to have strategically best location, which is one of the reasons for its academic growth. We are presently offering seven different Masters degree courses, including Masters in Medical Devices. To ensure excellent growth of medical devices industry in Gujarat, NIPER Ahmedabad is also mandated to have a national centre for medical devices. If you want to develop medical devices, we cannot ignore the contribution of Ireland. We have an MoU with University of Galway for developing the department of medical devices at NIPER Ahmedabad.”

ehealth.eletsonline.com | OCTOBER 2017

CONFERENCE REPORT

The state of Gujarat is way upfront in the field of pharma as well as in food, especially in edible oils. Gujarat, particularly Saurashtra, has a very strong foothold in edible oils. Adani Wilmar Limited is the largest producer of oil not only in Gujarat but also in India. We understand that food has two very important aspects. The first is of course to provide nutrition, but also with the rise of non-communicable diseases the food has a very big role to play. Perhaps there is very distinct overlap between food and pharma industry in India because they compliment and supplement each other to a large extent. Food has a very large role to play in our lives than we realise. The more we become careful as an industry to look after the nutritional side, safety aspect and also the ethical aspects, perhaps the dependence on pharma can be reduced to a large extent.â&#x20AC;?

Sukanya Choudhury Vice President Regulatory Affairs, GSK

Biprabuddha Chatterjee Head, R&D, Adani Wilmar Limited

Sukanya Choudhury, Vice President-Regulatory Affairs, GSK answering queries of the participants.

OCTOBER 2017 | ehealth.eletsonline.com

To attain the next level of growth, we need to continue on the journey of regulatory harmonisation. In a broad sense, regulatory harmonisation refers to commonalities in technical requirements and guidelines for regulation of medicines, which basically will allow us to achieve the ultimate objective of providing high quality, effective and safe medical products to the patients in India and across the world. In order to embark on the journey of harmonisation, there are initially lot of differences within the regulatory mechanism across all the markets. But markets today are moving towards a state of convergence and harmonisation, which is the ultimate goal. Harmonisation is not just common documentation being created for regulatory use and the use of the industry, but also effective communication and collaboration between regulators, industry and other stakeholders like patient groups and academia to ensure the overall end goal. All this will lead to a very collaborative approach to drug registration across markets and will pave the way for mutual recognition in long term. What we do not mean by harmonisation, which sometimes is speculated that just because something has been approved in a particular market we need to adhere to that. But it is not necessarily true. It does not mean loss of national sovereignty or autonomy in taking a decision whether a particular product is suitable for the market. Harmonisation allows sharing of information freely amongst all the regulatory authorities, and finally the decision lies with the regulatory authority depending on what is the need of that nation.â&#x20AC;?

CONFERENCE REPORT

We are manufacturers of Indian sweets and namkeens. We have shops in Bhavnagar, Baroda, Surat and Ahmedabad. The Food and Pharma Summit has given us better understanding of the regulatory requirements and knowledge about the food sector. The summit is set to go a long way in helping the industry grow.â&#x20AC;?

Dr Vishal Rajgarhia Marketing Director Finecure Pharmaceuticals

Baiju Mehta

Managing Director, Das Pendawala

The Gujarat Government and Gujarat FDCA are very industry friendly. Our FDCA was the first to go digital in India, which is very commendable. From the industrial growth perspective, the pharma industry is going to grow double its current size in the next four years. This doubling of the growth figure will happen mainly because of rise in lifestyle diseases, increased purchasing parity in the country and increase in awareness. However, the industry needs to provide customised solutions and remain ahead in innovation. The viruses are advancing so we need to address such issues. There are so many drugs for anaemia, but there is the problem of gastro that needs to be addressed. Gujarat has always been ahead in innovation. We have 109 years of pharma legacy and a very good talent pool of pharma professionals. We have institutes like NIPER (National Institute of Pharmaceutical Education and Research), Nirma, etc, and we also have autonomous bodies which work hand in hand with the industries, helping them in areas like R&D and incubation.â&#x20AC;?

The special issue of eHEALTH magazine being released at the National Food & Pharma Summit, Gujarat.

ehealth.eletsonline.com | OCTOBER 2017

CONFERENCE REPORT

Technology and innovation play an important part in improving food business. Honest as a group is present in India in a big way and has recently grown in the US, Thailand and Dubai as well. Earlier, the kitchen used to be at the back but now it is coming at the front because of these new food handling methods. Restaurants are now using more hygienic ways to prepare food. Technology, hygiene and improved quality of food hold the key to the success of this industry.”

Dr Prabodh Halde

Head Regulatory Affairs, Marico Pvt Ltd

Raj Mittal

Managing Partner, Honest Reveira

Pharma is a Rs 2 lakh crore industry, while food is a Rs 16 lakh crore industry. We have a population of 1.3 billion and every person requires three meals a day. On an average, every family purchases around Rs 3,000 worth of food every month. We have 40 crore families in India and 1.2 lakh crore is spent on food alone, which is huge. But the problem with the food industry is that we are not organised. Unlike pharma sector, where close to 99 per cent industry is in organised sector, nearly 75 per cent of food industry is in unorganised sector. The moment food industry is organised, we will be comparable to the food industry in the US or UK, where 80 per cent food processing is happening in organised sector as compared to 8.2 per cent in India. We Indians don’t change the taste so easily. So, the next challenge for the industry would be how to use modern science in traditional food. Two types of forces are currently at work – the technology pushing forward and the market pulling backward.”

Eminent speakers at the National Food & Pharma Summit, Gujarat.

OCTOBER 2017 | ehealth.eletsonline.com

In 2010, India was at the 56th position out of 180 countries in the Global Innovation Index. The country was ranked based on its performance on 83 parameters. In 2011, we slipped to 62nd position, in 2012 to 64th, in 2013 to 66th position, in 2014 we were given 76th position, and in 2015 we further slipped to 81st rank. But fortunately, the new government at the centre has undertaken many policy changes which reversed our slip in Global Innovation Index from 81st to 66th position in 2016. The growth rate of Chinese innovation is almost three times that of the US. Earlier, we regarded China as a manufacturing hub. Today, we are aspiring to be a manufacturing hub like China through ‘Make in India’. But we also need to innovate along with manufacturing. In 1996, the Chinese government started 5,000 nodal centres across the country to train their industry, academia and students even at school level in Intellectual Property Rights (IPR), which includes patents, copyright, trademark, etc. They realised that in 21st century we need to innovate and protect it for the world to recognise China as a technology hub. Last year, Chinese filed 8 lakh patents, while the US filed 6 lakh 20 thousand patents. Last year (2016), 48,000 patents were filed from India, which included all big companies, academic institutes like IITs, etc.”

CONFERENCE REPORT

A linkage between academia and industry is required. India is the third country in terms of pharmaceutical manufacturing capacity. We supply pharma products to many countries across the world. But in terms of valuation of the industry, we are at the 13th position. The important question that arises now is where are we in terms of innovation as a country. We are in the range of 50-100 when it comes to getting ranked in innovation.

Rajesh Gandhi

Managing Director, Vadilal Industries Ltd

Earlier, there was a serious issue that if there was .1 per cent less fat in ice cream from the standard 10 per cent then it was a crime and the minimum imprisonment was of 6 months. That draconian law has now been changed. The Gujarat officials have been very positive on many small issues like when the batch number on some packed food items is not visible or there is some manufacturing defect, they take it with a positive and supportive attitude. Innovation and technology is a vast subject. Bitcoin has become the world’s biggest bank with no cash, Uber is the world’s largest taxi service with no vehicle of its own, Facebook is the world’s most popular media owner which creates no content and Alibaba, the world’s most valuable retailer has no inventory. When we talk about innovation, there has to be cohesiveness. The R&D people, consumer scientists and technocrats have to work together to find a solution which brings smile on the face of the customer. Innovation in the food industry can be in areas like nutraceuticals, which can reduce the medicine intake. Then there are natural food ingredients, functional foods, organic food, frozen food, in terms of growing of vegetables -- aeroponics and hydroponics are being talked about where no soil is required for growing vegetables. There are companies that are trying to grow meat in labs using algae. Some of the packaging innovations include paper board. There is also new storage technology like ARS (Absorption Refrigeration System), which does not require human intervention.”

Dr Manish A Rachchh Director (R&D) and CEO Accuprec Research Labs Pvt Ltd

ehealth.eletsonline.com | OCTOBER 2017

NATIONAL FOOD & PHARMA AWARDS

1. Leadership Award for Implementing Best eInitiatives - Commissioner, Food and Drugs Control Administration, Government of Gujarat 2. Leadership Award for Best Egovernance Initiatives - Food and Drugs Control

Administration, Government of Maharashtra 3. Leadership Award for Best Administrator in Food Safety Standardisation - Food Safety Commissioner, Health & Family Welfare Department, Government of Odisha 4. Leadership Award for Best Practices in Drugs Quality Enforcement - Drugs Controller, Drugs Control Administration, Health & Family Welfare Department, Government of Odisha

5. Leadership Award for Innovation in Healthy Food Product - Adani Wilmar 6. Leadership Award for Innovative Pharmaceutical Products GlaxoSmithKline 7. Leadership Award for Using Best Innovative Technology in Healthcare - Cipla-Caring for Life 8. Leadership Award for Innovation in Quality & Product Development - Finecure Pharmaceuticals Pvt Ltd

OCTOBER 2017 | ehealth.eletsonline.com

9. Leadership Award for Innovative Approach in Food Packaging - Das Pendawala Pvt Ltd

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