Ehealth oct16 web edition

eHealth Magazine

2nd Annual

Healthcare SUMMIT

Asia’s first Monthly Magazine on the enterprise of healthcare Volume 11

Issue 10

October 2016

EDITOR-IN-CHIEF: Dr Ravi Gupta EDITORIAL TEAM - DELHI/NCR Assistant Editor: Souvik Goswami, Gautam Debroy, Kusum Kumari, Sandeep Datta Senior Correspondent: Manish Arora BANGALORE BUREAU T Radha Krishna - Associate Editor MUMBAI BUREAU Kartik Sharma - Senior Assistant Editor Poulami Chakraborty - Correspondent JAIPUR BUREAU Kartik Sharma - Senior Assistant Editor CHANDIGARH BUREAU Priya Yadav - Assistant Editor HYDERABAD BUREAU Sudheer Goutham B - Senior Correspondent LUCKNOW BUREAU Arpit Gupta - Senior Correspondent AHMEDABAD BUREAU Hemangini S Rajput - Assistant Editor SALES & MARKETING TEAM: eHealth Product Head: Fahim Haq, Mobile: +91-8860651632 Senior Executive: Priyanka Singh, Mobile: +91-8860651631 SUBSCRIPTION & CIRCULATION TEAM Manager Subscriptions: +91-8860635832, subscription@elets.in DESIGN TEAM Creative Head: Pramod Gupta, Anjan Dey Deputy Art Director: Om Prakash Thakur, Gopal Thakur, Shyam Kishore EveNt Team Manager: Gagandeep Kapani ADMINISTRATION Head Administration: Archana Jaiswal EDITORIAL & MARKETING CORRESPONDENCE

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Contents

October 2016 | VOLUME - 11 | ISSUE - 10

13 Exclusive Interview

BSBY: Our Pledge to People for Free & Best Medical Services

Rajendra Singh Rathore Medical, Health & Family Welfare Minister, Government of Rajasthan

18 Exclusive Interview

Learnings from Past, Paving the Way to Betterment Veenu Gupta Principal Secretary, Department of Medical Health & Family Welfare, Government of Rajasthan

22 Exclusive Interview

Keep BSBYing, Keep Helping

Naveen Jain Mission Director, National Health Mission, and CEO State Health Assurance Agency, Government of Rajasthan

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Emergency Ambulance Services

Cover Story

GVK EMRI: Ready to Experiment New Spaces

44 26

Sarve Santu Niramaya

K Krishnam Raju Director GVK EMRI

Major Healthcare Initiatives

Realising Greatest Strengths of Healthcare via Collaboration, Not Competition

Key Healthcare Initiatives 62

58 Om Kasera MD, Rajasthan Medical Services Corporation Limited

e-Mamta: Harnessing Benefits of ICT to Promote Institutional Delivery

Bincy Baby Director, Eram Scientific Solutions

Other Interviews

66 Sivachenduran B Co-founder & Managing Director, Danvanthiri Medical Tourism Private Limited

Telemedicine 52

Dr Biswa N Mohanty President, Telemedicine Society of India

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Ganesh Narain Saxena Dean, Mahatma Gandhi University of Medical Sciences & Technology, Jaipur

Krishnamurthy Ramalingam CEO & MD, Galactic Medical DataBank Private Ltd

72 Sumit Singh CIO Wockhardt Hospitals

Shipra Dawar Founder ePsyclinic.com

editorial

Rajasthan – Realising True Growth in Healthcare via Technology & Cashless Health Insurance Rajasthan as a state has always set an example before other states by conducting an open dialogue to advance public-private partnership (PPP) in the healthcare space. Due to the consistent efforts of the Government of Rajasthan, the tie between both public and private sectors has strengthened with time and has heralded the phase of active collaboration between the two sectors on healthcare challenges. In the light of Government of Rajasthan’s commitment to PPP and continuous delivery of successful healthcare initiatives, eHEALTH Magazine came up with the idea to conduct 2nd Healthcare Summit in the pink city of Jaipur to bring together all thought leaders and healthcare stakeholders on one platform. During the Summit, we will be also launching a Special Issue to provide a holistic view of the Rajasthan Healthcare. eHEALTH Magazine feels extremely privileged to include exclusive interviews of Hon’ble Rajasthan Health Minister Rajendra Singh Rathore; Veenu Gupta, Principal Health Secretary, Ministry of Medical, Health & Family Welfare, Government of Rajasthan; and Naveen Jain, Mission Director, National Health Mission, and CEO, State Health Assurance Agency. Beginning with these interviews, we come across decision-makers driven with the mission to ensure 100 per cent coverage by including the poorest & the neediest. It seems there has never have been a better time in the healthcare space of the Rajasthan State, as it seems to be currently. It gives us an immense sense of satisfaction that the healthcare industry is in the safe hands of such thinking and imaginative guides and leaders. These leaders are ready to hear all, as well as answer all. In our opinion, the remarkable e-initiatives, such as ASHASoft, e-Upkaran, Online JSY And Shubhlaxmi Payment System (OJAS), etc., are successfully delivering access to both authentic information and healthcare services at fingertips. eHEALTH Magazine has also brought forth some of the extraordinary projects and concepts, such as electronic toilets, Asha Jyoti, e-Mamta, etc., being run by private companies and in other states to solve contemporary healthcare issues, such as spread of communicable diseases & infection, increased MMR & IMR, etc. Catch hold of this extraordinary issue to widen your understanding on healthcare programmes being run across Rajasthan and other states. We also seek an opportunity through this space to invite all healthcare stakeholders to come in large numbers to the 2nd National Health Summit scheduled on 23rd September 2016 in the pink city of Jaipur. Come and enlighten our journey in healthcare! As we often say, it’s not by getting out of the world that we become enlightened, rather by getting into the world.

Dr Ravi Gupta ravi.gupta@elets.in

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Announcements

Announcements & Budgetory Allocations

1 2

Progress

4 1 2 3 4

Total Amount of Registered Claims Total Amount Submitted Total Claims Approved Total Amount Paid

Time (Dec 2015 to Sep 2016)

Highlights of Rajasthan Budget 2016-17 • 43,000 families benefited under Bhamashah Health Insurance in a short time. • Upgradation of 2 sub-centres to primary health centre (PHC) • Opening of 5 new PHCs & upgradation of 8 PHCs to community health centre (CHC) • Increase in the number of beds in 8 CHC-District Hospitals • Upgradation of CHC, Chaksu to Satellite Hospital • Rs 1,716 crore for National Health Mission (NHM) • 100 new dental chairs and 7 mobile dental vans for divisional headquarters • Rs 5 crore for new beds, wheelchairs, beds, etc. in government hospitals • Colour Doppler Machines in 3 districts • Rs 31.10 crore for new buildings of sub-centres, PHCs and CHCs

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• Distribution of tricycle, hearing aid, etc. on the basis of e-health card • Continuation of community-based malnutrition management programme • Raising the retirement age of allopathic doctors in Medical, Health and Family Welfare Department and medical teachers in Medical Education Department to 62 years. • 16 newborn stabilisation units to be upgraded to special newborn care unit- Rs 5 crore • Food security labs in 5 more districts - Rs 27.50 crore • Rs 5 crore for new Swasthya Bhawan Building • 3 Aanchal Prasuti Kendra, 9 Panchakarma Kendra, 11 Jarawasta Centres and 6 Prakritik Chikitsa Kendra to be established.

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Voice of Leader

Adoption of Good Policies & Technology â&#x20AC;&#x201C; Talisman of Healthcare Problems

Faggan Singh Kulaste Minister of State Ministry of Health & Family Welfare Government of India

eeping in mind the fact that technology plays a vital role in widening the healthcare services, we are adopting worldclass technologies to ensure efficient medical and healthcare service delivery across the country. Our Prime Minister Narendra Modi has expressed concern about providing healthcare services to rural and difficult areas. It was a big challenge to deliver better healthcare services to villagers at their doorstep. But we have tried to ensure this by adopting good policies and technology within the department and the situation has improved a lot at ground. Our metropolitan cities do have both private and public facilities in healthcare. There is a need to spread awareness among people and if we worry about this more than other factors then half of the healthcare problems can be solved. The really important factor is that we need to involve more number of people in healthcare. We are trying to strengthen the role of National Health Mission (NHM) in different states with adequate support of all people. It requires collective efforts from all communities, as well as the government and private industry. The suggestions and feedback coming out of vibrant sessions happening at this summit should be submitted to the Ministry of Health & Family Welfare to strengthen healthcare ecosystem.

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Exclusive Interview

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Exclusive Interview

BSBY: Our Pledge to People for Free & Best Medical Services Through openness towards newer technologies & partnership models, Rajasthan has already established milestones in the healthcare sector. In order to ensure better management of not just medical devices but also of data and findings, the Government of Rajasthan has intelligently leveraged technology to make services much better and easier to access. Interestingly, its key healthcare initiatives, such as e-Upkaran, Jeevan Vahini, Bhamashah Swasthya Bima Yojana, etc. are steps that can prove a point of reference for other states, shares Rajendra Singh Rathore, Medical, Health & Family Welfare Minister, Government of Rajasthan, in an exclusive interview with Kartik Sharma and Arpit Gupta of Elets News Network (ENN) Rajasthan has been the hub of innovation and in last 1 year, many new innovations have been done. What is your take on this? Our Government has been in power for last 2.5 years. And, as a Medical, Health & Family Welfare Minister, I am aware of the priorities of Rajasthan. Rajasthan is the biggest state of India from the geographical point of view and we have 7.5 crore people living here. Information technology (IT) in healthcare is a need for us and our team at the National Health Mission (NHM) is doing a great job. Since your last health summit, we have undertaken some new measures. We have introduced Kuposhan Watch and mobile applications for recording the inspections of officials. We have done e-Upkaran for biomedical maintenance and also introduced Bhamashah Swasthya Bima Yojana. We have also introduced an integrated ambulance system called Jeevan Vahini which is first-of-itskind in India.

In your earlier answer you mentioned about

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Exclusive Interview

Kuposhan Watch and mobile applications. Can you please throw some light on them? Kuposhan Watch is a software that is used at malnutrition treatments centres (MTCs). We have around 40 big MTCs where malnourished children come from far-flung villages in Jaipur. Since we were not able to know details regarding the total number of children visiting the centres, getting good treatment and going away with some benefits, Kuposhan Watch was introduced to keep a watch on such details. Currently, this software is doing fine and we hope to improve it further. Additionally, Mobile Saghan Nirikshan Abhiyaan (MSNA) is a mobile application downloaded by our officials at both district and state levels. Whenever these officials will go to primary health centres (PHCs) and sub-centres, they are required to record their findings in the app. By this way, we have done away with paperwork. As a result, we are likely to witness the entire culture of paperless office. The findings once recorded are analysed by our development partners. Based on the findings and analysis, we take key decisions. In last 6 months, more than 15,000 inspections have been done all over Rajasthan.

e-Upkaran was showcased at the National Summit in Tirupati and many states have showcased interest in doing similar innovations. Please walk us through the key benefits of e-Upkaran? Rajasthan is a big state and we have around 3,000 institutions, ranging from primary health centres (PHCs) to medical colleges. We also have a lot of medical devices. Therefore, there is a need to create a system to use and maintain medical equipment in a good way. Whenever there is a breakdown, a helpline should be available to access repair and

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Key Initatives • e-Upkaran for biomedical maintenance • Jeevan Vahini - an integrated ambulance system • Kuposhan Watch – a software used at MTCs • Mobile Saghan Nirikshan Abhiyaan (MSNA) – To record findings in the app by officials at both district and state levels

Bhamashah Swasthya Bima Yojana is a cashless health coverage scheme that is being successfully run across Rajasthan and has become a reference point for other states

maintenance services. e-Upkaran system will ensure the above. We have made the software with the help of Centre for Development of Advanced Computing (C-DAC), and Rajasthan Medical Services Corporation (RMSC) has been given the responsibility of handling the day-to-day management of this project.

On 13th December 2015, Rajasthan became one of the states to launch healthcare insurance scheme called Bhamashah Swasthya Bima Yojana. Can you please throw some light on the scheme? Our honorable Chief Minister in her budget announcement had declared that Rajasthan state will have a very comprehensive and ambitious insurance scheme for the poor people. We have taken beneficiaries of the National Food Security Act (NFSA) as the beneficiary. We have given them protection against more than 1,700 types of disease packages. Additionally, in case of general diseases, there is a package of Rs 30,000 and in case of critical

illness, the package goes up to Rs 3,00,000. As of my knowledge, no state has given this much of coverage to its public. Therefore, Bhamashah Swasthya Bima Yojana is a unique scheme and is to a large extent extremely practical. We have kept it cashless, which means patients have to not pay anything. Since 9 months of its launch, the scheme has been doing extremely well and has claimed more than Rs 200 crore.

What are your future plans for the department? Though we are still experimenting a lot with information technology (IT), the next phase of experimentation will be mobile technology. Everybody is talking about the extensive use of mobile in day-to-day life of the Indian population. I have instructed my department to create such platforms where a poor man with a mobile can access a lot of healthcare services and information about diseases, hospitals and other related matters. Hopefully, we will be able to achieve by next year when you come for the next health summit.

Exclusive Interview

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Exclusive Interview

Learnings from Past, Paving the Way to Betterment

In an exclusive interview with Kartik Sharma and Arpit Gupta of Elets News Network (ENN), Veenu Gupta, Principal Secretary, Department of Medical, Health & Family Welfare, Government of Rajasthan, shares the challenges and gaps confronting the healthcare sector of the Rajasthan state. With her wide experience and knowledge, she highlights the key lacunas, such as high MMR and IMR, in appropriate use of CSR funds, etc., and measures to fill the gaps and strengthen the healthcare sector and investment As you recently joined the Medical, Health & Family Welfare Department of Rajasthan, how has been experience so far in the department? As such, Rajasthan is a very diverse state with numerous challenges, particularly in the social sector. I have conducted review meetings of all the programmes on a one-to-one basis. Overall, I have found that there are still many challenges that need to be overcome. However, I can say that although a lot of ground has been covered, we are still struggling with high maternal mortality rate (MMR) and infant mortality rate (IMR). We are trying our best to deal with this problem, so that at the national level Rajasthan can prove that both MMR and IMR are our priority and we are focused upon reducing them.

quite promisingly. It is able to achieve many of the objectives as any software should be able to. Besides this, there are some managerial and administrative issues, of which maximum have been resolved. More efforts are required on the IEC front.

What is your take on the use of information technology (IT) in healthcare? IT has been across both Moreover, concept has

used by all the sectors Rajasthan and India. e-governance as a become the buzzword,

particularly with the increased focus by both central and state governments. However, we should be very conscious while implementing and using IT. Personally, my view is that whenever we use IT, we should try to make it very simple so that the people to be benefitted from such IT interventions can comprehend the benefits. Both consumers and patients should be able to make appropriate use of IT interventions and such interventions should not be limited only to the department.

What is your opinion on Bhamashah Swasthya Bima Yojana (BSBY)? BSBY was launched in December 2015. The scheme witnessed teething problems. With time, many of the issues have been resolved and some of them are in the process of resolution. Overall, I believe the team is working in the right direction. The software behind the entire scheme has evolved

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Exclusive Interview

Rajasthan Government under the leadership of Vasundhara Raje has undertaken many healthcare initiatives compare to other states to address needs of the commen masses; Veenu Gupta, Principal Health Secretary, Government of Rajasthan, aims to make it stronger by addressing gaps through regular reviews

Therefore, it should be advertised and publicised very well. Besides this, if there are interventions for the department people, proper videoconferencing, meetings and reviews should be conducted to make them understand the way to use the technology. I think IT is the need of the hour. Therefore, all states, including Rajasthan, must use it extensively to cut down the cost.

What is your take on corporate social responsibility (CSR)? As such, I have been working in the Department of Industries for quite long. We conducted a very good event called Resurgent Rajasthan on 19th and 20th November 2015 in Jaipur, with the primary objective of attracting investment from private sectors and sensitising them for investment in Rajasthan. Overall, many people are investing in Rajasthan. According to the Companies Act, many corporate companies with their big profits are supposed to contribute to the CSR. However, I have seen that there is a lack of coordination between the CSR funds and the departments

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Key Takeaways • Working intensively on reducing both MMR & IMR on a priority basis • The software behind the entire BSBY has evolved quite promisingly • In the next 3 months, BSBY can prove to be an ideal health insurance scheme • Make IT simpler to make it more customer or patientfriendly • Need to conduct more meetings & reviews to fill the gaps in appropriate use of CSR funds that require those funds. Because of my previous experience, I can assist my department to get more and more CSR funds. Though there are many gaps, these can be filled through the appropriate use of these funds. Our department can guide people on where to invest the money coming from CSR. I think next year can prove very crucial in engaging CSR funds and filling the gaps in our healthcare sector.

What is your take on public-

private partnership (PPP) in healthcare? Given the enormous challenge in the health sector, efforts are being made to rope in energies and efficiencies of private sector to supplement government efforts. We have launched schemes for PPP in primary, secondary and tertiary care. For the PPP model to succeed, change of mindset is a must, especially at the district and sub-district level. The private partners should be given a fair chance to prove their worth.

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Exclusive Interview

Keep BSBYing, Keep Helping In an exclusive interview with Kartik Sharma and Arpit Gupta of Elets News Network (ENN), Naveen Jain, Mission Director, National Health Mission, and CEO, State Health Assurance Agency, Government of Rajasthan, shares how Rajasthan as a state has been enhancing the current projects by focusing on strengthening of software and integrating other advanced features to make the healthcare offerings better and much more developed compared to other states. You have undertaken various initiatives in information technology (IT) in the last 2 years of your tenure. What are you planning next? What initiatives have been implemented in last 1 year? When eHEALTH conducted its health summit in July 2015, we showcased ASHA-Soft, which is an online payment and monitoring system, and we were in the process of introducing Online Job Application System (OJAS), which is an online payment module. Now after 1 year, I can say that we have evolved further with our other two biggest innovations that include e-Upkaran and integrated ambulance project. As such, both the projects have attracted attention of many in India and the main force behind the success of these two projects is their software architecture. The e-Upkaran module will take care of repair and maintenance of equipment along with keeping an eye on their usage. We have mostly seen that devices are not being used efficiently, so such an innovative system will keep an eye and generate alerts to the institutions. As far as an integrated ambulance system is concerned, every state has

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many types of ambulance systems and none of them are on a single command. In Rajasthan, we thought of creating a single command and converging different ambulance numbers, such as 104 and 108, on one call. Furthermore, we included

base ambulances which were not used optimally. Now, the integrated ambulance system has Emergency Ambulance Service (108), Medical Advice Service (104), 104 Janani Express and base ambulances that are operational from all health institutions along with a helpline call centre. In this way, these four elements have been integrated in one and it is backed by a very strong software. There is a mobile application for drivers, along with a navigation procedure built in the system. This enables drivers to reach the site at the right time and whether he is on the right track or not.

What are your plans in the coming years? We would like to consolidate our previous IT interventions. In the last 2

Exclusive Interview

years, we have done around 10 to 12 interventions. Some of them are very big and huge in their size. In last 1.5 years, ASHA-Soft has evolved very well and many states are now following us. In fact, some of them have implemented it. OJAS has also come up very well and we are further improving it to make a good software. Integrated ambulance project software and e-Upkaran software have already started, but we are analysing their performance. We would like to make them as much user-friendly as much possible. In 2017, we would be consolidating softwares rather than building a new one. In addition to that, we will be soon coming up with electronic Vaccines Intelligence Network (eVIN). The project has been supported by the United Nations Development Programme (UNDP). In more than 2,000 cold chains of Rajasthan, we have installed the sensors. There is machine called ‘Temperature Logger’ which gives an indication about vaccines whether they are stored at optimal temperatures or not. Maintaining the potential of vaccination and avoiding the stock out is the main purpose behind the implementation of this software. By merely sitting in Jaipur, we can know about the vaccination process and its status. All the cold chain handlers have been united in a common user group and the entire effort will be launched soon. Interestingly, it will help us in saving a lot of money by avoiding the wastage of vaccination. We have more than 2,000 cold chains and maintaining so many cold chains and keeping vaccination intact is a big challenge. eVIN will help us and we have installed sensors and loggers on these ice-lined refrigerators (ILRs) which are there in cold chains. Additionally, all the cold chain handlers have been given SIM with a mobile app. They will feed the data and at the Jaipur level we can

Key Takeaways • Has created an integrated ambulance system with numerous ambulance systems on a single command • Has developed a mobile app for drivers and built in a navigation procedure built in the system • Focuses on creating a dashboard while developing softwares for better decision-making • Have evolved with two biggest innovations that include e-Upkaran and integrated ambulance project • Will be soon coming up with electronic Vaccines Intelligence Network (eVIN) • Has given SIM with a mobile app to all the cold chain handlers • More than 15,000 inspections have been with the help of the mobile app Mobile Saghan Nirikshan Abhiyaan (MSNA) • Has strived hard to evolve the software of Bhamashah Swasthya Bima Yojana very well • Maintains social media handles to share Bhamashah Swasthya Bima Yojana details and other success stories

Government of Rajasthan is working upon strengthening Bhamashah Swasthya Bima Yojana by improving quality and addressing other challenges in the system

get the summary of what is happening in the immunisation sector. Next year, we would also like consolidate all our previous softwares and innovations. Our mobile application, Mobile Saghan Nirikshan Abhiyaan (MSNA), which was developed with the help of the United Nations Population Fund (UNFPA) and BSG Group is also running well. More than 15,000 inspections have been done, but now there is a need to analyse the data. Based on this analysis, decisions will

be undertaken.

How Rajasthan is different in terms of implementation of IT from other states? Actually, through our various government projects, we collect a lot of data; however, we are not adequately using the data. Whenever we develop a software, we are very particular about ‘dashboard’ to ensure that the person responsible at the helm of affairs should be in the

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Exclusive Interview

ASHAs, which is not an easy task, at Atal Seva Kendras. Again IT was of great help. As many of the guidelines were neither formulated nor clarified, we formulated and clarified them and put them on our website. I think now our website is very much structured. We also maintain a Twitter handle, Facebook page and Google+ account. Using social media, we can share with people the performance details of the scheme, as well as share the problems, performance and success stories that motivated people to go for the scheme. I think involving ASHAs and social media, making all the guidelines and evaluating the software and finding the gaps and solving the software problem also came handy.

position to see the points where he should make interventions. Almost every state project, such as ASHASoft, OJAS, Kuposhan Watch, etc., has been given such dashboards, as well as analytical reports. Based on these analytical reports, we are able to find the gaps and fix the responsibilities. We are promoting the champions and trying to give message to the wrongdoers. This is how IT is making impact on the healthcare sector.

You are also the CEO of Rajasthan State Health Assurance Agency. You have been given the tough task of running this scheme? How has been your experience? Yes, I was given the charge of Bhamashah Swasthya Bima Yojana (BSBY) in February 2016. Initially, there were many issues related to the functioning of software, as well as there were some issues regarding the package rates. The claims were very less and whatever claims we were having were not processed on time. Additionally, there was no system to keep a check on “progress”. I can claim that in the last 6 months,

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with our constant efforts, we have been able solve many problems. We thank our insurance company called New India Insurance Company, as well as Department of Information Technology under the leadership of Shri Akhil Arora, who has been kind enough to look at the various problems and now the software has evolved very well. Now various protocols and guidelines have been established. This was the first year of the schemes, so naturally such challenges were expected. We have been able to understand the problems and devise solutions.

What are your future plans? What do you think what has worked actually? How could you come out from the problem? As such, BSBY is doing well and all are saying that it has taken off. We need to ensure that the actual beneficiaries come to know about the scheme. The involvement of accredited social health activists (ASHAs) has proven to be the game changer. We conducted videoconferencing with 40,000

What are your future plans for BSBY? In very first year, the BSBY scheme has been able to make a dent. Now, many people know about this scheme. We need to work on the quality aspect. As the schemes will grow and new private hospitals will join with us, there may be chances of fraudulent practices. Earlier in many states it has been reported that health insurance schemes are being misused, but we will be very much alert about this. Insurance agency is sending its team to many hospitals for inspections. Whenever they conduct such audits and sudden inspections, we support them fully. They have deempanelled some of the hospitals and we have kept their decisions intact. We have not changed their decisions as this will create an atmosphere of trust amongst the hospitals and companies. I think we will work on the people’s complaints. Whatever complaints we are getting, we have asked the district collectors to investigate into them. Either it is a complaint from a normal beneficiary or a complaint from a hospital not getting payments from the insurance companies.

Cover Story

Sarve Santu Niramaya Kartik Sharma, Arpit Gupta and Kusum Kumari of Elets News Network (ENN) explore or try to comprehend how the Rajasthan healthcare space is getting taller by shorter but relevant steps undertaken by the Government of Rajasthan. The policymakers have been mounting all challenges by being constantly devoted to the overall objective of consistent growth and enhancement of healthcare services to ensure easy access and seamless delivery of medical care to all. “Healthy citizens are the greatest asset any country can have” - Winston S. Churchill

ndoubtedly, a healthy nation is a wealthy nation, which is realisable only through the strengthening of healthcare space and by bringing out healthcare initiatives for better diagnosis, treatment, prevention and management of not just diseases, illnesses and injuries, but also for the preservation of well-being in people. Moreover, the strengthening of the entire healthcare service delivery is equally important to ensure quality care reaches the neediest of all without any condition attached with the services. In order to make healthcare service delivery seamless and hassle-free, technology can play a vital role, especially mobility and information technology (IT) through the adoption of mobile devices, in providing services at fingertips. With the constant evolution in the mobile technology, healthcare providers are

October / 2016 ehealth.eletsonline.com

also interestingly experimenting with a range of devices. Never has healthcare come across so exciting and ready for experimentation as it seems to be currently. In the similar vein, Rajasthan has demonstrated leadership in the healthcare space by leveraging technology and constantly striving towards making the system much better by fixing the gaps. As mentioned in the September issue of eHEALTH magazine, ‘preventive care’ as a concept is now steering the entire healthcare sector. And, undoubtedly, it has also emerged as the core objective of the Government of Rajasthan. Despite being the largest state from the geographical point of view, the Government of Rajasthan aims to reach the remotest corners and empower the poorest to achieve the vision of quality healthcare for all. Accelerating this objective further, the Government of

Rajasthan has undertaken a series of e-initiatives, especially under various programmes of the National Health Mission (NHM), and introduced first-ofits kind mobile applications. Interestingly, some of the mobile applications, such as Kuposhan Watch, introduced by the Government of Rajasthan focus on the recording of data and inspections of officials. It seems the Government is now much more particular about enhancing the system and tools by integrating advanced technologies and other features to provide holistic solutions to the common masses. Tracking of information related to newborn deliveries, maternal care, etc., has always been a daunting challenge for the policymakers throughout India. In the absence of adequate data and information on the above segments, the policymakers often witness roadblocks

Cover Story

in addressing the gaps. The Government of Rajasthan has come out with a Pregnancy, Child Tracking & Health Services Management System (PCTS). Enabled with a dashboard, PCTS allows decision-makers to plan better health policies by going through the data under different categories, such as Total Antenatal Care (ANC) Registered, Total Deliveries, Total Births and Total Children Registered. According to the gaps identified during the process of review, the Government of Rajasthan can revise and design health policies accordingly. With the coverage of 16,500+ health institutions and all 44,000+ villages, data capturing right from the scratch is now possible through PCTS. Data generated right from the primary healthcare centre (PHC) to hospitals are collated at one place. Moreover, PCTS is integrated with the portal of as Mother & Child Tracking System (MCTS) of Government of India to generate a central database. PCTS is also integrated with the portals of ASHA-Soft for online payment service and Online JSY and Shubhlaxmi Payment System (OJAS) for direct benefit transfer. In order to ensure timely delivery of payments to Accredited Social Health Activists (ASHAs), as well as ensure effective monitoring, the Government of Rajasthan came up with the online application ASHA-Soft. Interestingly,

Innovative e-initiatives like ASHA-Soft are empowering ASHAs and district-level programmes

this system with no capital investment not only allows informed decisionmaking, but also better utilisation of the existing SMS gateway and banker. Undoubtedly, ASHA-Soft has proven to be a boon for ASHAs across Rajasthan, as well has emerged as a reference point for other states for ensuring effective monitoring of ASHAs and the programmes. Recognised and awarded on different platforms, ASHA-Soft has been strengthening the entire system by monitoring the performance of different districts on multiple parameters, such as Total Payments, Monthly Meetings, National Programme, etc., and empowering anganwadi workers by offering opportunities related to

Government of Rajasthan - Major e-Initiatives  Kuposhan Watch: For monitoring the real-time status of children with severe acute malnutrition admitted in MTCs and providing assistance for complete healthcare  Pregnancy, Child Tracking & Health Services Management System (PCTS): Tracking of information related to newborn deliveries, maternal care, etc.  Online JSY and Shubhlaxmi Payment System (OJAS): Facilitates users to capture beneficiary-wise details of payment for JSY and Shubhlaxmi Yojna  ASHA-Soft: Ensures effective monitoring of ASHAs, districts and programmes, as well timely delivery of payments  Rashtriya Bal Swasthya Karyakram (RBSK): An online platform focusing on improving the overall quality of life of children  IMPACT Software: Enables registrations of sonography centres and tracking of activities  Integrated Ambulance Service Project (IAP): Dial an Ambulance Service Project for operationalisation of the existing fleet of more than 1,400 ambulances deployed at different parts of the State

higher education, etc. Another key e-initiative has been OJAS Software, which facilitates users to capture beneficiary-wise details of payment for JSY and Shubhlaxmi Yojna. Once again, this tool has been playing a key role in monitoring the performance of each delivery, online payments, and timely and transparent payment for beneficiaries and system. With the growing focus on malnutrition as a medical emergency, especially in an emerging country like India, the government at both state and central levels have been have been working at a breakneck speed to decrease the number of malnutrition cases, particularly in the rural areas. To shoulder this burden equally, the Rajasthan Government recently launched Kuposhan Watch to monitor real-time status of children with severe acute malnutrition admitted in Malnutrition Treatment Centres (MTCs) and assists in providing complete healthcare. Along with the tracking facility, Kuposhan Watch provides access to facilities and officials in the hierarchy for data analysis. Additionally, it has the facility to send automated alerts and voice-based reminders to both parents and caregivers. With the increased concentration

october / 2016 ehealth.eletsonline.com

Cover Story

on mother and child care by the Government of Rajasthan, Rashtriya Bal Swasthya Karyakram (RBSK), an online platform focusing on improving the overall quality of life of children, was started in April 2014. In order to ensure equitable child healthcare, the tool enables early detection and treatment. It enables a systematic approach to child health screening and early intervention. With the intention to regulate sonography centres indulging in abortion or termination of pregnancy, the Government of Rajasthan started IMPACT Software, or Integrated Monitoring System for Pre-Conception, Pre-Natal Diagnostic Technique (PCPNDT) Act, on 1st October 2012, in compliance to the order of the Rajasthan High Court. With more than 1,470 sonography centres registered online and more than 2,000 tracking devices installed, the system allows real-time monitoring and ensures effective implementation of the PCPNDT Act of the state. The system was designed and developed by National Informatics Centre – Rajasthan. Some of the additional features of the system are generation of analytical reports, search tools and provision of feedback. The detailed report enables the policymakers to conduct a demography study and comprehend the gaps. This software has proven to be a progressive step towards reduction of sex-determined activities. The Government of Rajasthan has initiated Integrated Ambulance Service Project (IAP) as Dial an Ambulance Service Project for operationalisation of the existing fleet of more than 1,400 ambulances deployed at different parts of the State. Presently, 741 equipped 108 Ambulances, 600 Janani Express Vehicles and 200 Base Ambulances are operational in the State, along with a centralised call centre for 108 and toll-free 104 Medical Advice Service. There is an integrated software for the management of 108 Ambulances/104 Janani Express/

October / 2016 ehealth.eletsonline.com

Under the scheme, various tertiary care treatment are provided to BSBY beneficiaries at multi-speciality private and government hospitals at free of cost as envisaged by Government at the time of launch of the scheme. In brief, progress under major diseases packages are as follows1. Cardiovascular & Cardiothoracic and Vascular Surgery: a. 1,490 claims of Bypass Surgery (coronary artery bypass graft surgery (CABG) amounting Rs 4.37 crore are booked under the scheme. b. Claims of 685 Heart Valve Repair treatment are booked so far amounting Rs 7.23 crore. c. Till date 3,133 Angioplasty claims are booked worth of Rs 17.06 crore. d. 156 claims of Congenital Heart Disease are also booked under the scheme amounting Rs 1.03 crore. 2. Cancer: More than 15,689 claims of cancer treatment (chemotherapy, radiotherapy and surgery) are booked so far amounting Rs 19.90 crore. 3. Brain Surgery: 1,490 claims of brain surgery are booked under the scheme so far and claims amount of Rs 4.37 crore is booked. 4. Spinal Surgery: 1,123 claims of spinal surgery are booked and cost of such claims is Rs 3.35 crore. 5. Lung Surgery: 105 claims of lung surgery are booked under the scheme which costs around Rs 34.41 lakh. 6. Plastic Surgery: 330 claims of plastic surgery amounting Rs 1.16 crore are booked under the scheme. Base Ambulances/Medical Advice/ Invoice Generation. Global Positioning System (GPS) devices have been installed for the identification of vehicle locations. For this, integrated Geographical Information System (GIS) Mapping of all government health institutions, accredited private hospitals, fire stations, police stations and all ambulances have been done. To provide round-the-clock prehospital emergency transportation care (ambulance) services across the State, integration with SMS gateway and email, and integration with mobile application for reporting of inspection/ vehicle status has been done. There is a control room at Swasthya Bhawan for monitoring and verifications of calls 24/7. Health insurance in India is a growing segment of India’s economy. The Bhamashah Swasthya Bima Yojana (BSBY) was launched in the state on 13th December, 2015 for around 1 crore eligible families of Rajasthan. The main objective of this scheme is to provide cashless healthcare services to the poor families of Rajasthan, thus, providing social and financial security against illness to these families and reducing out-of-pocket expenditure. Families identified under the

National Food Security Act (2010) and the Rashtriya Swasthya Bima Yojana (RSBY) are eligible for taking treatment at empanelled hospitals under the scheme. Naveen Jain, Chief Executive Officer, State Health Assurance Agency, Department of Medical, Health & Family Welfare, Government of Rajasthan said, “Our Chief Minister is making colossal efforts to improve the health sector and encourage a healthy, preventive lifestyle. Under her leadership, Rajasthan will be able to turn the aspiration of ‘sarve santu niramaya’ to reality.” Till date, total 469,765 claims have been enlisted under the BSBY amounting Rs 224.39 crore while total 302,743 claims have been approved by NIAC amounting to Rs 133.79 crores. This is a good claim status, especially in a State like Rajasthan where there is prior existence of other blanket cover health care schemes like Mukhyamantri Nishulk Dawa Yojna (MNDY) and Mukhyamantri Nishulk Janch Yojna (MNJY). In BSBY, participation of private sector is increasing day by day. The number of empanelled private hospitals has shot up by three times since the launch of the scheme (from 167 to 568). Districts like Udaipur, Tonk,

No. of Claims Submitted Aug

38649

20876

July

36018

13637

June

46946

17057

May

49915

Cover Story

14335

Govt. & Private Share in Claim Submission Over Government & Private Share in Claim Submission Over Months Months 0%

20%

40% Government

60% Private

80%

100%

No. of Claims Submitted

Amount Submitted (Lakh) Amount Submitted (Lakh)

No. of Claims Submitted 38649

July

36018

June

46946

May

17057

June

20%

40% Government

60% Private

80%

20000

17069.84 14045.47 15000 10736.41 10000 7397.41 4873.94 5000 2742.05 164.23 1016.43 29-02-2016

30-04-2016

30-06-2016

31-08-2016

July June

60% Private

80%

100%

1731.02

12210.97 10489.98

1155.07 5260.00

678.35 1303.53

8117.47

3098.67

1447.19

30-04-2016

30-06-2016

31-08-2016

1257.35

Total Claims Approved (Rs. in Lac)

20%

40% Government

60%

80%

100%

Total Claims Private Approved

13379.17

14000

11879

12000

9015.43

10000

Rs. In Lac

40% Government

1559.69

14112.3 11771.29 6086.3 3888.84 2135.56 124.9 769.55

20%

till 29th Feb, 2016

19652.29 17305.85

8903.33

1257.35

1559.69

1137.92 14000.00 12000.00 10000.00 8000.00 982.45 6000.00 4000.00 338.26 2000.001420.76 0.00

May

Total Amount Submitted (Rs. in Lac) Total Amount Submitted 20000 18000 16000 14000 12000 10000 8000 6000 4000 2000 0

1447.19

1420.76

Total Amount Paid (Rs. in Lac) Amount Submitted (Lakh) Paid Total Amount Aug

31-12-2015

1155.07

982.45

100%

1731.02

1137.92

May

14335

TotalAmount Amount ofofregistered claims Total registered claims 22438.52 (Rs. in Lac) 20353.77

25000

Rs. In Lac

13637

July

49915 0%

Aug

20876

Rs. In Lac

Aug

7196.23

8000

5194.58

6000 4000 2000

73.75 493.74

3693.65 2520.02 1419.89

31-12-2015

Jaipur, Sikar and Sirohi have shown participation of more than 50 per cent of total claim enlisting from the private sector. Various big corporate hospitals like Narayana Hrudayalaya, NIIMS, Mahatma Gandhi University, Geetanjali Medical College & Hospital and Pacific Institute of Medical Sciences are also associated with the scheme. “We have deputed Swasthya Margdarshak (Health Guides) at every hospital to help patients visiting hospitals and facilitate the complete process of BSBY scheme. Their job is

29-02-2016

30-04-2016

30-06-2016

31-08-2016

to check the family eligibility card, get the patient admission done and guide the patient at various levels till the treatment is done,” informed Jain. The Government is steadily moving in the right direction. Recently, a videoconferencing with around 46,000 ASHA sahyoginis was done under the chairmanship of Health Minister. Three rounds of ASHA Samwad were accomplished and ASHAs were thoroughly oriented about the scheme and majorly about their role in reaching out to the community

BSBY: In a nutshell  Cashless treatment facility in the inpatient department (IPD).  Packages offered under the scheme (total 1,715): Maximum number of packages; 1,148 secondary packages, 500 tertiary packages and 67 government-reserved packages.  Health insurance cover of Rs 30,000 (for general illnesses) and Rs. 3 lakh (for critical illnesses) per family per year on a floater basis.  Health institutions: The scheme is being implemented at empanelled private hospitals and medical college & associated hospitals, district hospitals, sub-divisional hospitals, satellite hospitals and community health centres (CHCs). Presently, 480 Government and 568 private hospitals are providing services under the scheme.  Includes 7-day pre-hospitalisation and 15-day post-hospitalisation expenses.  Major stakeholders: The Department of Medical, Health & Family Welfare owns the scheme and the Department of Information Technology (DoIT) and the New India Assurance Co. Ltd. are the key partners.

was highlighted. They were also equipped with BSBY kit, including dummy of ration card, Bhamashah Card, pamphlets of private hospitals, frequently asked questions, etc. As it is a huge scheme, an essence of prompt and proper grievance redressal is realised by Government and for this purpose, a system of grievance redressal has been established at district and state level. For the purpose, Grievance Redressal Committees have been established at state and district level under the Chairmanship of CEO of State Health Assurance Agency and District Collectors, respectively. These committees are in place to address the complaints of people, empanelled hospitals, etc. Additionally, a separate call centre is established at Swasthaya Bhawan, State Headquarter, which registers the grievances of the public. As system is also established for getting independent feedback from the beneficiaries so that future improvement may be done accordingly. In the feedback, one fact is revealed that more than 90 per cent of the beneficiaries have been satisfied with the services offered under the scheme. According to them, if there was no such scheme, they would have to either take a loan or mortgage their lands for want of better treatment. In order to ensure better implementation and in depth monitoring of the scheme Government has planned reviews at the level of seven divisions of Rajasthan, wherein specific divisionrelated issues and problems have been addressed. Required handhold support is also extended to all divisions during these reviews.

From 13th July, 2016, Bhamashah card has become mandatory for getting benefits under the scheme. However, RSBY card is being honoured in the transitory phase till all such RBSY beneficiaries are incorporated in the Bhamashah database.

october / 2016 ehealth.eletsonline.com

Exclusive Interview

The New India Assurance Co. Ltd: Enabling Patient-Centric Healthcare We are the sole insurers for BSBY in Rajasthan and our performance has been exemplary. This is first health insurance scheme of its kind for the masses, which is being managed and serviced directly by any Non-Life Insurance Co. in India, without the assistance of Third Party Administrator (TPA), says G Srinivasan, Chairman and Managing Director, The New India Assurance Co Ltd., in an interview with Kartik Sharma and Arpit Gupta of Elets News Network (ENN)

october / 2016 ehealth.eletsonline.com

Exclusive Interview

What is the strategy of New India Assurance to enhance customer service in healthcare sector and taking insurance to the last mile? To take care of our customers we have developed Online Portals through which they can buy Online Insurance. We have dedicated marketing force of our own Inhouse Marketing Executives as well as a large robust and dedicated Agency force, which is capable of taking our Healthcare products to the farthest corner of the country. In order to provide effective service to our customers, we have enhanced our reach by way of 2300+ brick and mortar offices located all over the country. The above efforts are backed up by 24x7 call centers and a seamless I.T. driven grievance redressal mechanism to resolve customer issues.

You have strong presence PAN India. Do you also see opportunity in rural areas? There is huge opportunity in rural areas, which is largely untapped. We are exploring this opportunity and making the most of it by way of our 1300+ Micro Offices/Extension Counters .We are also putting efforts in making use of Central Govts. E-governance initiative by enrolling and integrating Common Service Centres in our I.T.Network. Common Service Centres, which are portals manned by Village Level Entrepreneurs (V.L.E.). The drive for rural penetration is further supported by Micro Insurance Agents.Micro offices are mostly one man offices, which take care of the need of rural masses by way of educating them about the product and giving the required services.

Health Insurance is traditionally the largest segments for the industry.

New India Assurance being the largest non-life Insurer opened 1.5 crore accounts under Pradhan MantriSurakshaBimaYojana (PMSBY). Did it help a lot to create awareness on insurance? Yes, it is a great initiative by our Visionary Prime Minister, Honâ&#x20AC;&#x2122;bleShri NarendraModi to popularize the concept of Banking and Insurance amongst the masses. In keeping with his larger aim of Financial Inclusion of the rural masses supported by extensive publicity campaign, the concept of insurance and resultant security has reached the masses. By way of Camps, claim distributions by VIPs especially cheque distribution and word of mouth publicity from customers has further helped in spreading the concept of need of insurance.

New India Assurance is in the process of expanding its overseas operations and is preparing to open office in Canada and Qatar. What is the plan and progress? Yes, we are in an expanding mode in our overseas operations.

We already have presence in 28 countries by way of direct branches, agency operations and subsidiary companies. For Canada and Qatar, we have readied the pitch and awaiting clearance from the concerning Govt. authorities.

BSBY is being led by New India Assurance in Rajasthan. What has been the performance so far? What is the claim ratio ? We are the sole insurers for BSBY in Rajasthan and our performance has been exemplary.This is first health insurance scheme of its kind for the masses, which is being managed and serviced directly by any Non-Life Insurance Co. in India, without the assistance of Third Party Administrator (TPA). Total No. of claims reported so far has been 4.73 lacs amounting to Rs.226 crores. The policy commenced from 13th December 2015 and will be expiring on 12th December 2016. So there are roughly 3 months remaining for the policy to expire. The sheer number of claims amply proves our dedication and effort to take the health care services to the rural masses in Talukas, Tehsils and Villages.

october / 2016 ehealth.eletsonline.com

Affordable Healthcare Services

Rajasthan Medical Services Corporation Limited: Offering Quality Products & Competitive Prices to Needy Despite healthcare services getting advanced day after day, we still lack adequate facilities that can provide full-fledged services to the needy. With the intent to provide healthcare and medical care services to all equally, organisations like RMSCL has been taking initiative in this direction. Om Kasera, MD, Rajasthan Medical Services Corporation Limited, shared information related to initiatives & objectives of RMSCL in a special interview with Kartik Sharma and Arpit Gupta of Elets News Network (ENN) Please throw some light on RMSCL and its day-to-day operations. Rajasthan Medical Services Corporation Limited (RMSCL) is a well-known centralised procurement agency for procuring generic medicines, surgical sutures and medical devices for the Medical, Health & Family Welfare Department, Medical Education Department and other departments. Currently, we purchase medicines and medical equipment of around Rs 400 and 200 crore, respectively. Market of these medicines has the tendency to grow 10 times more at the value of Rs 4,000 crore. More importantly, if we at RMSCL did not take a step to buy these drugs of Rs 400 crore and distribute in the system, then people have to pay Rs 4,000 crore to the private pharma companies. And, we always look forward to provide our services to the people of Rajasthan.

RMSCL started with free medicine schemes which gained success and got equal support from the government too. But, do you face any challenge once the government gets changed? Healthcare has always been in the priority list for the Government of Rajasthan, irrespective of whichever

october / 2016 ehealth.eletsonline.com

Government comes to power. In the previous Government, the budget was Rs 200 to 250 crore, which has now touched Rs 400 crore. This undoubtedly is a significant increase. We are undertaking more and more contracts and business is running in an efficient way.

What kind of relationship do you have with your partners or tender companies? For us, business efficiency is the key to progress. Our relationship with our partners is very independent and that is one reason why we have made our separate corporation for the government department. On the other hand, companies associated with us are very professional in their approach. Overall, a lot many companies participate in tenders and a major increase in the number of participants has been witnessed. Last time, about 125 companies, who illustrate our credibility and trust, participated in the tenders. Such an increased participation exhibits the growing eagerness and willingness amongst the companies to be associated with us.

What do you do to have fair and

perfect relationship with your partner or supplier companies? All RMSCL tenders are open tenders who associate through an e-tender portal of Rajasthan, procurement portal of Rajasthan, etc. Interestingly, all tenders roll in through an online process, wherein anybody who files a tender is able to see information related to all the participating companies and documents submitted by them, as well as participate in the tender process. Therefore, it is a very transparent system and we do not accept any document offline. Moreover, even the competing companies can view the filed documents and can freely come out with complaints if they come across any kind of issue. Every company is equally allowed to participate in the system, subject to our technical qualification criteria. As such, we are very particular about quality at multiple levels. The following are the qualification criteria for the participants: â&#x20AC;˘ Must fulfill a turnover of at least Rs 20 crore in the last 3 financial years â&#x20AC;˘ Must have valid healthcare certifications for the products that the company is quoting. â&#x20AC;˘ Need to have a drugs certificate regarding the fulfillment of all

Affordable Healthcare Services

•

• • •

•

relevant financial and legal technical compliance. We also conduct a step-by-step drug quality testing when drugs reach the district warehouses: Each drug is tested in laboratories. Quality checks & drugs are properly examined. Before distribution, apart from the in-house test report, double check is a necessity in our system. After passing standard quality in pharma, drugs are permitted for distribution from distributor to wholesaler to retailer to the public.

Though drugs are properly examined, as mentioned by you, there is still sentiment in the public that government medicines lack standard in quality and it is believed that private healthcare medicos are better. Therefore, don’t you feel that there is a need to create awareness among end users? Yes, this is still a huge challenge. However, as notified, whatever medicine we buy will cost only Rs 400 crore. On the other hand, the same medicines are sold in the market at the value of Rs 4,000 crore. The remaining margin of Rs 3,600 crore is distributed at various levels, such as doctors, pharmacies, chemists, companies, distributors, wholesalers, etc. Demonstrating value of the same medicines in a negative way is just a way to mislead and continue to earn through chain. To put it simply, there is no possibility of any difference in efficiency or quality of the same drug sold through government or private model.

Don’t you feel that medical practitioners, especially the doctors of the state, are needed to be sensitised more. What’s your say on this? Yes, there is a need to make our medical practitioners more sensitised. In the beginning, we came across this problem; however, now things are very

Key Takeaways • Purchases medicines & medical equipment of around Rs 400 & Rs 200 crore, respectively • Provides adequate access to information related to participating companies & tender processes • Conducts random audits • Aims to serve humankind, irrespective of any community, belonging, etc. streamlined. Every doctor is instructed by the order of Chief Secretary to prescribe generic name of the medicine instead of the brand name. We also carry out random audits to keep a check on any kind of medical negligence by the doctors and wherever any unbearable act is found then necessary action is taken against that.

Free healthcare services of Rajasthan have gained popularity all across the country. Moreover, it has been observed that people from other states come to Rajasthan to avail benefits of free medical care. What is your opinion on this? We always aspire to serve humankind irrespective of any community, belonging or citizenship. Everyone has the right to get the right treatment at the right point of time and stay healthy. We always look forward to provide our services in the healthcare sector. More importantly, this money comes from the tax paid by the public and it should be used only for the humankind.

In terms of technology, online presence has gained importance in the lives of people. Even RMSCL is having online presence

through various portals like e- Tendering, e-Aushadhi, etc. What is the success rate of such portals? Do they really serve the purpose? We have been actively implementing technology to deliver efficient healthcare service and have been 100 per cent successful. Our portals are developed in-house and are used for supply chain management, inventory management, etc. It is a very robust model. As a result of such technological interventions, reports can be easily generated, avoiding any misappropriation. In the coming era, we will be able to witness the major change in public healthcare services, equipment, etc. Our web-based application i.e. e-Aushadhi: • Deals with the management of stock of various drugs, sutures and surgical items required by different district drug warehouses of Rajasthan. • Helps in ascertaining the needs of various district drug warehouses in such a way that all the required materials/drugs are constantly available to be supplied to the user district drug warehouses without delay. • This includes classification/ categorisation of items, codification of items, etc. • The prime objective of a district drug warehouse is to supply drugs to the various medical institutes that are associated with the given district drug warehouse.

E-commerce has gained prominence all across the world. Even e-pharma and other online portals are selling medical care products. Doesn’t this affect your business? RMSCL is not executing business for profit purpose. We purchase and distribute medicines free of cost to the needy. Our services are being provided to the people who are unable to afford even basic treatment or are economically feeble.

october / 2016 ehealth.eletsonline.com

WISH Model

Transforming Primary Healthcare through Innovations and Partnerships Wadhwani Initiative for Sustainable Healthcare (WISH) has been transforming primary healthcare through partnerships and innovations. Through its unique model based on identification of innovations, first-of-its-kind public-private partnerships, sustainable long-term financial model and leveraging of efficiency, WISH has delivered consistent success.

n countries with underperforming primary healthcare, diseases that are easily managed with proper diagnosis and medication become debilitating, even deadly. They rob families of income and have ripple effects through already vulnerable poor communities, where lost income can mean lost economic activity across the community, and lost educational opportunities for children. It is a situation that plays out all too often across India – where over 6 million people fall into poverty every year because of healthcare costs. Making basic healthcare available and affordable is the key to changing these realities. Primary healthcare is the first point of care and is critical for people’s health, including preventive, promotive and curative care. While significant global resources have been focused, very effectively, on curbing specific diseases like smallpox, family planning, safe motherhood, HIV/ AIDS, tuberculosis (TB) and malaria, relatively little has been done to strengthen primary care in an integrated manner, the backbone of an effective healthcare system.

WISH has developed a unique, innovation-led model to transform underperforming primary healthcare systems in India and can be applied to low-income countries around the world.

october / 2016 ehealth.eletsonline.com

Sunil Wadhwani Founding Donor, WISH

The WISH model is built on four key strategies: • Identify the most promising healthcare innovations, offer innovators a platform for health technology assessment, provide test-beds for further validation, then facilitate the process of scaling up within the public system. We identify, field test in our health centres and bring to scale the most promising innovations – devices, technologies and processes - that save time and money, improve access and quality of care, and ensure transparency and accountability in the delivery of healthcare services to the nation’s most vulnerable populations. • Develop first-of-their-kind PublicPrivate Partnerships (PPPs) that

bring together state governments, international agencies and best-in-class private sector healthcare partners. Building these partnerships ensures the sustainability of our work, both financially and in terms of long-term impact and success. • Leveraging efficiency, accountability and economies of scale, provide primary care services for an operating cost of under $2 per patient served. Over time, cost-savings will increase further as effective primary and promotive care prevent illness and bring down the number of costly emergency hospital visits. • Build a sustainable long-term financial model for primary care delivery. The government provides all the facilities and infrastructure, medical equipment, medicines and consumables. During the initial 6-month pilot period, WISH covers 100 per cent of all other operating costs, largely for doctors and other personnel expenses. Once the model proves successful, the government takes over 80 per cent of the operating cost for the following 5 years, with WISH covering 10 per cent, and other donors the remaining 10 per cent. After 5 years, all management, progress monitoring and accountability systems are transitioned to the government, which covers 100 per cent of all costs. Regular third-party evaluations are built into the model.

WISH Model

A Showcase of Success: The WISH Model in Rajasthan In early 2015, the WISH team presented its model to the Government of Rajasthan (population of 69 million). Our approach was welcomed and the Government signed a 5-year agreement with WISH to establish a high-quality primary healthcare delivery system in 12 of the highfocused districts in the state with a total population of 20 million. These districts are in remote areas with difficult terrain, high levels of poverty and poor health indicators. As of today, WISH’s programme is fully functional with the Organisation managing 32 underperforming public health institutions (PHCs) and 162 sub-centres (SCs) across 16 blocks in 12 districts of Rajasthan. WISH has introduced a variety of technologies, systems and process innovations, increasing efficiency, cost-effectiveness and health impact. In less then 2 years, all of these 194 centres were made fully functional – cleaned and painted, fully staffed with doctors and other personnel, functioning medical equipment, essential medicines in stock, and assured availability of services. These centres treat all conditions that patients come in with, but they focus on family wellness, maternal and child care, and promotive healthcare. As a result, patient demand has skyrocketed. Outpatient volume surged from under 29,000 patients in June 2015 to over 70,000 patients in August 2016. Similarly, Institutional deliveries have increased from 280 per month to 497 per month. Child immunisation levels are growing, as are antenatal and postnatal visits. Here’s how the four strategies in the WISH model played a key role in this transformation: • Identify and scale up the most promising healthcare innovations. WISH teamed up with the World Bank/ International Finance Corporation (IFC) to conduct a national search

and identified nearly 200 high-impact innovations; this list keeps growing as innovators approach WISH. The organisation identified 15 most promising innovations and provided them grants, management and technical assistance. These include:  Point-of-care diagnostic devices that reduce cost per test by 70 to 80 percent: A low-cost Glucometer, a non-invasive anaemia screener, a portable breast cancer screening device, and a mobile pathology lab that can do 37 tests and yet fits in a suitcase.  HealthATM: At locations without doctors, these kiosks provide basic diagnostic services, telemedicine consultations and an integrated vending machine by which the remote physician can dispense precise quantities of over 80 medicines.  mHealth: Cell phone and tabletbased apps that digitalizes data reporting, monitoring/supervision and standardised behaviour change communication delivery.  Electronic Medical Records that track health encounters, ensure adherence and monitor the effectiveness of programmes. The Rajasthan Government has included several of these innovations in its Program Implementation Plan for 2016-17, which makes them eligible for large-scale procurement by the state agencies. Several other state governments have approached WISH about introducing these innovations. • Work with government to establish an effective PPP platform. WISH staff worked closely with the Rajasthan Government to formulate PPP policies and establish a standard operating procedure (SoP). Having seen the remarkable results in the WISH-managed public health centres, the Government is bringing this model to an additional 1,000+ health centres. The WISH-managed public health centres will be used

by the government as “Model Centers” to assess the performance of the others. Several other state governments have now approached WISH about introducing its model more broadly. • Provide high-quality primary care for under $2 per patient visit. Due to the efficiency and accountability systems in the WISH health centres, the operating cost has come down to $2.30 per patient within a short period of one and a half year. Our goal is to bring this to under $2, which would make this one of the most cost-effective programmes in the world. Overall cost savings are significant, with reduced illness, fewer work days and school days lost, and significantly reduced emergency hospital visits. • Build a sustainable financial model for primary healthcare delivery. The Rajasthan Government is providing all the facilities and infrastructure of the 194 WISH-managed public health centres, medical equipment, medicines, and covering over 70 to 85 per cent of the operating cost. WISH is contributing 10 to 15 per cent of the operating cost, and other donors are being approached to provide the remaining 10 to 15 per cent of the operating cost. In 5 years, the centres will be transitioned to the Government, along with management, accountability and third-party monitoring systems established by WISH. The United States Agency for International Development (USAID) has committed $2.5 million in support of this programme in the states of Rajasthan, Madhya Pradesh and Odisha, and other additional states like Delhi, Haryana, Himachal Pradesh and so on to further scaling this partnership as we make progress. WISH has entered into another corporate partnership with the Aditya Birla Finance Ltd (ABFL), for managing 2 PHCs in the district of Udaipur.

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Paediatric Care

NIPI Newborn Care Project: Strengthening Paediatric Care via Offering Standard Practices at Doorsteps NIPI newborn care project is playing a crucial role in reducing IMR through evidence-based interventions to bring forth standard infant care practices, and that too at home through home visitation. Additionally, by making paediatric emergency care services functional, an increased number of children are being attended in the emergency department.

he Norway-India Partnership Initiative (NIPI) newborn care project team has developed and implemented innovations in the 13 districts of 4 states, including 3 districts of Alwar, Dausa and Bharatpur in Rajasthan. The newborn project activities have been implemented for providing catalytic, innovative and strategic support to assist states in reducing neonatal and infant mortality. The following innovations were successfully implemented and scaled up in the last 5 years: Home-Based Newborn Care Plus (HBNC+): This is an innovative packaging and delivery of preventive and promotive evidence-based interventions for optimal infant care practices at home. This is implemented through community link workers (accredited social health activist (ASHA)), by home visitation at regular intervals. A total of 7,083 ASHA/ANMs were trained under HBNC+ in three districts of Rajasthan. Successful implementation in 13 districts through achieving a coverage of 70 per cent in 3 years has led to the

countrywide scale up of HBNC+ in all low birthweight babies. The innovation has shown improved nutrition indices in infants and when results were extrapolated has shown the potential to reduce under 5 mortality by 10 per cent using Lives Saved Tool (LiST). More than 1,90,000 infants have been initiated HBNC+ home visits in three districts since 2014 whereas 1,17,409 infants have received complete four visits. Emergency Triage & Treatment (ETAT) by Nurses: This innovation reduces treatment delays for sick children in health facilities by making the paediatric emergency care services functional. NIPI newborn team has demonstrated various models of emergency paediatric

care in district hospitals; thus, paving the way for countrywide scale up. MoHFW, GoI with technical support from NIPI, developed operational guidelines to facilitate the establishment of paediatric care services have been developed. In Alwar district of Rajasthan, a total of 4,293 children were attended in the emergency department since October 2015 requiring immediate care. Family-Centred Care (FCC) in SNCUs: FCC as a low-cost innovation is well aligned with India Newborn Action Plan 2014 and is serving as a platform to deliver (1) care of small and sick babies and (2) care beyond newborn survival. It also facilitates Kangaroo Mother Care (KMC) and optimal feeding for low birthweight babies. No additional human resources are required; currently, employed nurses & doctors provide FCC. This innovation leads to empowerment of mothers/parents for caring of sick and small babies while in the health facility and to continue at home after discharge. FCC has been started in SNCUs across the state. In SNCU, Alwar a total of 749 (43 per cent) mothers have received FCC sessions since October 2015.

ANNUAL REPORT 2011

NORWAY INDIA PARTNERSHIP INITIATIVE

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Kirloskar Technologies – Health for Millions by Efficient Equipment Maintenance Kirloskar Technologies, popularly known as KTPL and a part of the 100 year old, multi-billion US dollars conglomerate – Kirloskar Group, has been a successful healthcare enterprise for more than two decades. KTPL is committed to improve the standards of Indian healthcare. Based on this, KTPL is actively engaged with various state governments for managing and maintaining medical equipment installed in public healthcare facilities, such as primary health centres, community health centres, district hospitals and medical college hospitals. So far, Kirloskar Technologies has been awarded the maximum number of contracts for this ‘Biomedical Equipment Maintenance’ programme in three states that include Rajasthan, Punjab and Kerala. KTPL represents known global manufacturers of hightech medical devices in India, offering a multidisciplinary product portfolio catering to the fields of cardiac surgery, interventional radiology, interventional cardiology, neurosurgery, nuclear medicine, oncology, radiography, vascular surgery, minimal invasive surgery, and plastic & reconstructive surgery. KTPL is fulfilling the needs of the Indian health sector by equipping the hospitals with latest high-tech medical equipment. Amardeep Sethi, Managing Director, KTPL believes “The moot point of KTPL philosophy which thrives our presence is our commitment to ensure high level of uptime of our medical assets which are either supplied by us or we are only maintaining. This is so, because we strongly believe that a machine is as good as it performs.” “This mantra continues to guide us while we strive to bring newest technologies and solutions to fetch smiles of satisfaction on the faces of all the KTPL Stakeholders. In order of priority they are patients, healthcare fraternity, principals, shareholders and of course, KTPL team.” KTPL has added prestigious customer base such as Rajasthan Medical Services Corporation Ltd, Kerala Medical Services Corporation Ltd, and Punjab Health Systems CorporationLtd, All India Institute of Medical Sciences (New Delhi), Tata Memorial Hospital (Mumbai), Fortis Group, Max Group, Apollo Group, Jaslok Hospital, Leelavati Hospital, Dhirubahi Ambani Hospital, Jaideva Group of Hospitals (Bengaluru), BM Birla Hospital, Narayana Hrudayalaya and over 100 government medical colleges. KTPL provides efficient timely maintenance services to more than one hundred fifty thousand units of medical device – assets installed in around 4,500 government health facilities, from hospitals in districts towns to

primary health centres in remote rural areas. KTPL achieves this by making the optimum use of the latest technology for round-the-clock call services. A special tailor-made software is being used for recording equipment mapping and for acknowledging and resolving services complaint s withindefined time frame. Real-time dashboard display on breakdown, service progress and other reports is created for efficient maintenance management. Rajasthan Medical Services Corporation has developed acomprehensive software solution, e-Upkaran, to improve the inventory management and maintenance services of medical equipment in health delivery centres across the entire Rajasthan state. KTPL is functioning in line with the concept and application of this software to further improve maintenance efficiency. KTPL ensures that qualified, experienced and local culture friendly biomedical engineers, product and application specialists, and sales management staff are deployed to match the need of achieving high level of efficiency. Regular training sessions are held to update their skills and knowledge. At present around 200 KTPL team members are working at various locations in every nook and corner of India. To facilitate better customer contact, KTPL has offices in all major metro towns. KTPL is striving to contribute towards the health and happiness of millions of patients.

Emergency Ambulance Services

GVK EMRI: Ready to Experiment New Spaces In a candid interview with Kartik Sharma and Arpit Gupta of Elets News Network (ENN), K Krishnam Raju, Director, GVK EMRI, shares his opinion, vision and apprehensions with regard to ambulance services. With an increased focus on ambulance services by the state governments, GVK EMRI has learned the ropes of operating in a challenging environment at quite an early stage. And, it is now ready to grow the fleet to 14,000, as well as diversify into new areas of healthcare

GVK EMRI (Emergency Management and Research Institute) is doing a lot of work, especially in terms of publicprivate partnership (PPP), in Rajasthan along with the Government of Rajasthan. Can you please throw some light on what kind of initiatives are being undertaken?

transport patients on time and definitely during the golden hour.

So far, we have been implementing 108 emergency ambulance service along with the Government of Rajasthan in the entire Rajasthan state. Currently, the Government of Rajasthan has initiated an integrated emergency health service. In this system, they have included not only 108, but also 104 ambulance service under the Janani Shishu Suraksha Karyakaram (JSSK) scheme. With the introduction of this scheme, we will be able to cater to all pregnancyrelated cases in Rajasthan. Hopefully, by the end of 1 year, we will definitely be able to show a good reduction in infant mortality rate (IMR) and maternal mortality rate (MMR). Additionally, the Government of Rajasthan has introduced the ambulances with the purpose to serve anybody for travelling from one hospital to another hospital, home to hospital, etc., which need not be an emergency or JSSK service. The State wants to cover in particular women and senior citizens to provide

Earlier we were operating only 720 ambulances, but now onwards we

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We all know that Rajasthan is such a large state with a lot of rural population. What kind of measures are being undertaken to overcome challenges related to operating in Rajasthan?

support. Moreover, with the allowance given by the Government to use any ambulance for any other service, the response time to the beneficiary will come down. As a result, we will be able t o

Emergency Ambulance Services

plan to operate 1,400 ambulances. With the availability of double the number of ambulances now, even the rural population can be connected with the sheer increase in the number of the vehicles.

The IMR and MMR rates have always been a very big issue in Rajasthan. How far we will be able to address this challenge with the availability of such integrated systems? As such, we will be able to transport people, which can affect around 20 per cent of the population. However, for the remaining 80 per cent of the population, we need to appropriately equip hospitals with staff, beds and medical devices to take care of the patients. If these facilities are available right from the primary healthcare (PHC) level to other levels in the hierarchy, they will play a larger role in the reduction of IMR and MMR. Certainly, 20 to 25 per cent reduction is likely to be witnessed through an appropriate ambulance service. As a result of such a free ambulance service, the usual deliveries will definitely go up. There is a need to propagate the value of accessing such a service so that people use such an important service available for free.

Recently, we came to know about an incident, not in Rajasthan state, due to the scarcity of ambulances, people are being forced to carry dead bodies. Do you think there is less awareness about such ambulance services as being run by GVK EMRI? If the dead bodies are carried in regular ambulances, such as 108 and 104 ambulances, people will start indulging in backlash. Ambulances like those being run by GVK EMRI are run for free for emergency and delivery purposes. It’s high time that the Government must introduce

Prime Minister Narendra Modi has emphasised the role of emergency services in rural areas

Government of Rajasthan - New Initiatives • Has initiated an integrated emergency health service, including both 108 & 104 ambulance service under the JSSK scheme. • Has introduced ambulances to enable travelling from one hospital to another, home to hospital, etc. • Has allowed to use any ambulance for any other service mortuary ambulances. If enroute a person dies, then no one complains; however, transporting a dead person from home to the burial ground is not accepted.

How important is public-private partnership (PPP) in improving the overall services of GVK EMRI? Do you think there is a need for a better plan to ensure business efficiency for private providers? PPP, as far as ambulance service, is concerned is really important as it can help the masses. Fortunately, our earning is not for profit, rather our main motto is to serve people.

As such, GVK EMRI has its presence in 75 per cent part of the country and India is moving towards Digital India

by integrating technology as a game-changer. How is GVK EMRI planning to adopt technology, especially to monitor operations and vehicles? To monitor 11,000 ambulances, we need technology; therefore, we have introduced Global Positioning System (GPS) and adopted Google Maps. Additionally, we have supplied smartphones to all ambulances. Through such technological interventions, as well as a unique code provided to each ambulance, both location and movement of the ambulances can be monitored from Hyderabad. We have 46,000 people working across India and through technology we can monitor each associate. Additionally, our staff members keep everyone updated about the medical consumables

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Emergency Ambulance Services

manpower and other essential items from the neighbouring states, as well as take the help of the governments.

You have been the leader in this segment for a long time. How do you envision the emergency services in India? What is the future of emergency services and scope for improvement in India?

GVK EMRI provides excellent emergency ambulance services in the remotest parts of rural India

GVK EMRI - Key Takeaways • Plans to increase the fleet from 720 to 1,400 ambulances. • Need to propagate the value of accessing such a service. • Need to introduce mortuary ambulances. • Has introduced GPS & Google Maps • Has supplied smartphones to ambulances for better tracking • Uses technology to keep a check on the essential consumables to be replenished • Has introduced the concept of petro card consumed whenever they attend a particular case. As a result, this process enables to keep a check on the essential consumables to be replenished. Similarly, information related to the consumption of oxygen, position of medical devices and fleetrelated information, such as refueling processes, is also readily available. As oil companies have agreed to the payment to headquarters, we do not pay to the petrol stations directly. Therefore, we invented the concept of petro card. We have introduced at all the petrol stations the facility of swiping the petro card. The data generated through such petro cards will go to the oil company. Every day we get the bills automatically from all

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the 17 states where we are operating our ambulances. Once the bills have been received, we make the payment from Hyderabad. Oil companies are quite happy with our initiatives.

How is GVK EMRI planning to tackle emergency situations as recently we have witnessed strikes by your employees? As such, strikes are not a new concept in India. On any given day, there will be a strike in one or other district of the country. However, the governments are comparatively much proactive than the earlier times and they supply nurses, paramedics, drivers, etc. during such situations to fill the void. Additionally, we transport

As a matter fact, emergency services will increase with the development and increase in traffic and number of vehicles in the coming days. Currently, the Government of India supplies one ambulance for 1,00,000 people. In another 1 to 2 years, they have to make it one ambulance for 75,000 people and then in another decade, one ambulance for 50,000 people. By doing this, we will be able to save the Golden Hour and Reach Time, as well as save people in an effective manner.

Nowadays even heart transplants are being conducted in large numbers, for which the administration is also introducing the novel concept of Green Corridors/ Emergency Corridors to enable hassle-free rapid transportation of organs. Please provide details of the new initiatives being undertaken by GVK EMRI. In Tamil Nadu, we are transporting blood using separate vehicles. Interestingly, we have also introduced mobile bikes and boat ambulances. Apart from India, we are also operating in Sri Lanka for emergency services. For the police, we are also operating dial 100 in three to four states. For women helpline 181, we are operating in six to seven states. For the first time in Telangana, we are introducing emergency services for animals by including 200 ambulances with veterinary doctors. We are also focusing on air ambulances.

Inventory Management System

e-UPKARAN

(Centralised Inventory Management System)

ccording to the World Health Organization (WHO), for an efficient health system, the provision of equipment and diagnostics at a healthcare facility is as essential as the provision of trained medical professionals (WHO Report 2006). The Government has been working hard to facilitate the provision of equipment/others at the healthcare facilities, but due to poor management, it is proving out to be a herculean task. As a result, the Government healthcare facilities have to be the scapegoat due to inadequacy and low-quality services provided. The Government has made provisions for free drugs and free diagnostic investigations under various schemes, but the beneficiaries are not able to avail the services either due to absence or due to non-functional investigative machinery. During routine visits of the healthcare facilities, it was observed that equipment/others was lying unutilised in the storeroom at some places, while at other places there was gross deficit of the same equipment/others. It was also observed that at some facilities, the devices have been non-functional for a long time and despite multiple requests for repair & maintenance, the department has shown cold shoulder every time. Hence, there is an urgent need to establish a Centralised Inventory

• Ascertain the new needs and need base rationalisation • Established a biomedical equipment repair and maintenance system • Reduced equipment breakdown time • Quick win response with better coordination in health programmes • Better hospitals management in the State Management System for efficient functioning of all 2,971 healthcare facilities; therefore, e-Upkaran: EMMS (Equipment Management & Maintenance System), a complete system for equipment management and maintenance, was developed. The module in e-Upkaran includes equipment inventory module, equipment complaint/ maintenance module, equipment usage module and reporting module. The equipment new demand module and equipment transfer modules are on UAT. Presently, e-Upkaran includes four modules: • Inventory module • Equipment maintenance module • Usages module • Reporting module Outcomes • Improved health services • Centralised monitoring for optimum utilisations • Regular updated information and reporting

Progress • e-Upkaran was launched on 2nd October, 2015 by Hon’ble Health Minister. • The verification work has been done by chief medical and health officers (CMHOs) and PMOs. And, now the verification work of medical college hospitals has been undertaken. • The repair and maintenance of biomedical equipment agency Kirloskar Technology Private Limited (KTPL) was finalised by Rajasthan Medical Services Corporation Limited (RMSCL) and a memorandum of understanding (MoU) was signed between the Government and KTPL on 8th August 2016. • In first 3 months, the agency will complete mapping and repairing of all ‘non-functional repairable equipment’. After that, the agency will address R&M complaints round the clock work through e-Upkaran and a call centre.

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Telemedicine Society of India

Telemedicine - An Accessible Healthcare Dais

Information technology has eliminated the distance barriers and has made everything accessible to everyone, whether one is staying in rural or urban areas. In the healthcare sector, telemedicine is one of the biggest opportunity areas for service providers and takers who have been transmitting imaging and healthcare data from one to another. Improving accessibility of medical services, telemedicine permits communication between patients and doctors with convenience and reliability. In an exclusive interview, Dr Biswa N Mohanty, President, Telemedicine Society of India shared his views on the contribution of technology in healthcare sector and its involvement in creating ease for people staying in rural areas with Kartik Sharma and Arpit Gupta of Elets News Network (ENN)

Telemedicine has been witnessed as one of the booming sectors. Do you feel that it is a better technique to provide healthcare services in the remote areas? Definitely, it is. As we know, in India, the availability of the resources is not well distributed and we do not have enough number of doctors in the rural areas as we have in the urban areas. As such, technology is the only way out to offer better healthcare services to people who are unable to access it due to the lack of resources. It may not be just rural areas, in fact, even the large pockets of urban areas, such as slum areas or where we do not have government hospitals, are still unable to avail adequate healthcare services. To reach such far-flung places, we have the technology of telemedicine. Telemedicine is not the medicine itself, it is the technology which enable people to access those resources which may be far off.

Now, from general diseases to complicated ones, we have discovered teleophthalmology, tele-diabetes, etc. and other technologies.

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ACF has been working in India since 2010 ACF has been working in India since 2010 by by developing a holistic approach towards developing a holistic approach towards nutrition nutrition security. ACF currently runs nutrition security. ACF currently runs nutrition programs programs statesin–Madhya Rajasthan, Madhya ACF states has in been working India since 2010 by in three –three Rajasthan, Pradesh and developing aMaharashtra holistic approach towards nutrition Pradesh and – and also provides Maharashtra – and also provides technical security.assistance ACF currently runsother nutrition programs technical in few ones. ACFbeen has assistance few– Rajasthan, other ones. ACF has in threeinstates Madhya Pradesh and been working to raisealso public awareness and working to raise public andtechnical create a Maharashtra – and awareness provides create a movement on the problem of acute movement theotherproblem acute assistanceon in few ones. ACF of has been malnutrition, in order bringthe theand issue to the working toinraise public create a malnutrition, order totoawareness bring issue to the movement the problem of acute centre stage ofonpublic debate. centre stage of public debate. malnutrition, in order to bring the issue to the centre stage of public debate.

Vision: Vision:

Vision:

Fighting andand defeating food. Despite Despite India’s India’s Fighting defeatingmalnutrition malnutritionisisnot not just just about about distributing food. Fightingeconomic and defeating malnutrition is last not just about distributing Despite India’s remarkable growth over thethe last decade, millions are able tomeet meet themost most remarkable economic growth over decade, millions are still stillfood. not able to the remarkable economic growth over the last decade, millions are still not able to meet the most basic needs, like access and sufficient sufficientfood. food.ACF ACF basic needs, like accesstotonutrition nutritiontreatment, treatment, safe safe drinking water and basic needs, like access to nutrition treatment, safe drinking water and sufficient food. ACF organizes programs to save the lives of children affected by severe acute malnutrition and to organizes tosave savethe thelives lives children affected by severe malnutrition organizesprograms programs to ofof children affected by severe acuteacute malnutrition and to and to develop long-term sources of Income, creating self-sufficiency. develop sourcesofof Income, creating self-sufficiency. developlong-term long-term sources Income, creating self-sufficiency. Our global objective is to reduce the children mortality and morbidity that is related to acute Ourunder global objective is is totoreduce children mortality morbidity is related Our global objective reduce the the children andand morbidity that isthat related to acuteto acute nutrition in India. Our ultimate goal ismortality to create a Hunger Free India. nutrition in India. Ourultimate ultimate goal a Hunger Free Free India.India. underunder nutrition in India. Our goalisistotocreate create a Hunger

Mission:

Mission: Mission:

In the coming three years (2016-2018), ACF-India and FHF aim at scaling up their interventions In the coming three years (2016-2018), ACF-India and FHF aim at scaling up their 200 villages to200 1,000 villages located inACF-India 12 high burden districts three states: Madhya In from the coming three years (2016-2018), FHF aimof at scaling their interventions from villages to 1,000 villages located in and 12 high burden districts of threeup Pradesh, Rajasthan Maharashtra. interventions fromPradesh, 200and villages to 1,000 villages located in 12 high burden districts of three states: Madhya Rajasthan and Maharashtra. states: Madhya Pradesh, Rajasthan and Maharashtra.

Strategicpriorities: priorities: Strategic

Strategic priorities: In Inthe thisstrategy, strategy, Fight Hunger Foundation relies three key thecourse course of of implementing implementing this Fight Hunger Foundation relies on threeonkey pillarstotomake make its its expertise expertise and available to ato large number of beneficiaries while while pillars andservices services available a large number of beneficiaries In the course of implementing this strategy, Fight Hunger Foundation relies on three key carving a defined role in tackling acute malnutrition in India. carving a defined role in tackling acute malnutrition in India. pillars to make its expertise and services available to a large number of beneficiaries while carving a defined role in tackling acute malnutrition in India.

Telemedicine Society of India

Telemedicine is the technology which enables people to access far-off resources

Which all sectors have these technologies? The maximum use of such technologies has been in the radiology sector because we have a good number of X-ray machines in the country, but not enough number of radiologists. Therefore, X-rays are taken and the report is provided after some time. Nowadays, what people are doing is that after taking X-rays, they are sent to certified radiologist centres. On that basis, the experts give their opinion on the tests. Furthermore, it is applicable to all types of X-rays, such as chest X-ray, brain X-ray, magnetic resonance imaging (MRI),

computerised tomography (CT) scan, etc. Additionally, ophthalmology is another field that has benefited a large number of people.

As far as Rajasthan is concerned, how do you feel this technology will benefit the districts of Rajasthan and its people? Use of technology has already started making difference, the reason being doctors are actively heading with experiments and their experiences. They are going to villages, which have a need, a demand and are providing healthcare services.

Key Takeaways • Technology is the only way out to offer better healthcare services to people • Maximum use of telemedicine technology has been in the radiology sector • Telemedicine as a technology enable people to access those resources which may be far off • Need to spread awareness on the existence of such a technology • Telemedicine can be made accessible by deploying vans with basic treatment devices

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If there is a demand in any of the areas of the state, facilities will be made available. As a result, we now have amenities, such as medical colleges, large hospitals, etc. We have around 12 medical colleges in the state. To put it in simpler words, it means resources are there. It’s just a question of connecting the resources to the proper person. And for this, we have the technology telemedicine which is connecting the resources to the needy.

What are the major challenges being faced in the industry? As such, there are few challenges, of which the foremost challenge is that the people must know that such a facility exists. Secondly, the mobility of the telemedicine teams should be scalable. Initially, to make telemedicine accessible, we can have the vans with basic treatment equipment. For example, a day can be fixed for a particular village to provide healthcare services and as the resources augment, it can be increased for twice a week, thrice and so on.

Healthcare Solutions

Palladium: Transforming Lives via Linking Social & Financial Impacts

Palladium has been successfully delivering solutions to stakeholders ranging from investors, corporations, governments, etc. to devise mechanisms that create a successful marriage between public and private sector players to work towards common goals.

alladium is a leading international project management and consulting company specialising in feasibility studies, designs, and the implementation and management of both government and commercial large-scale projects for the government agencies, private clients and international development agencies.

Palladium – Key Functions & Services Palladium is also a global leader in the development and delivery of Positive Impact - the point where commercial and social goals are inextricably linked, and social and financial impacts are equally considered. We work with investors, corporations, governments, and non-profit organisations to deliver solutions that transform lives. Through this work with businesses, communities, societies and economies, we help to create enduring value. Over the past 50 years, Palladium has implemented more than 700 large-scale multi-year programmes in 120 countries worldwide. We currently have 2,500 personnel in our 30 major offices. We have 30 years of continuous experience working effectively with central, state and district governments in India, predominantly in the health sector, including 13 years of experience

in implementing public-private partnership (PPP) social marketing and social franchising RMNCH+A activities in Uttar Pradesh, Jharkhand, Uttarakhand, Odisha and Bihar.

Understanding Impact Bond Palladium, supported by Convergence (the first and only blended finance platform), has led the development of a maternal and newborn health (MNH) intervention aimed at improving MNH outcomes in the state of Rajasthan using an innovative financing mechanism known as an Impact Bond. Impact Bonds are resultbased contracts in which private investors provide pre-financing for social programmes, while public sector agencies pay back investors their principal plus a return if, and only if, these programmes succeed in delivering social outcomes. Impact Bonds provide a much greater incentive for feedback loops to collect and monitor data that supports informed decision-making during programme implementation by the service provider. Palladium is working with investors, outcome funders, the Government of Rajasthan, service providers, legal counsel in both the United Kingdom (UK) and India, and a UK-based leading proponent of impact bonds to finalise the design of this tool so that the investor funds can

be raised, and the implementation activities can commence as quickly as possible thereafter. By tying investors’ financial returns to the achievement of social outcomes, Impact Bonds create a distinct stakeholder group with a strong incentive to ensure effective and efficient delivery of outcomes. Private investors whose financial returns are tied to achieving social outcomes make the process of monitoring and ultimately achieving the agreed outcome targets more rigorous. These types of mechanisms are therefore a very concrete articulation of Palladium’s vision for the future – a world where private capital and private markets and private business aren’t just encouraged to work with public and non-state agencies towards common goals, but where tools exist that give these sometimes uncomfortable bedfellows a space that necessitates this collaboration, and where results and real impact aren’t the ‘nice to haves’ – they’re the reason for our existence! For more information on our work please contact Dr Amit Bhanot, Senior Regional Health Advisor at amit-bhanot@ thepalladiumgroup.com or Peter Vanderwal, Innovative Financing Lead at peter.vanderwal@ thepalladiumgroup.com.

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Telemedicine

Create New Business Models to Broaden Telemedicine Revolution

The healthcare sector is in changing mode and has been developing itself at a faster pace. Thanks to technology and remote healthcare services, quality care is now available almost everywhere to a large extent. Moreover, certain parts of the world have been quickly adopting technology for better delivery of services while making it available for each and every citizen of the country. In an exclusive interview with Kartik Sharma and Arpit Gupta of Elets News Network (ENN), Dr Ganesh Narain Saxena, Dean, Mahatma Gandhi University of Medical Sciences & Technology, Jaipur, shared his concerns, plans and opportunities for the country in the adoption of telemedicine as a technology in the healthcare sector Telemedicine has been lately witnessing a booming phase across India. What is your view in terms of progress of telemedicine in the country? Telemedicine in India is growing. In fact, most of the states in India today are using telemedicine. Initially, it was the Indian Space Research Organisation (ISRO), Department of Space, Government of India, which had taken the initiative to establish a telemedicine centre in almost every state. But now, most of the private hospitals, small clinics and medical personnel are accepting telemedicine as a way of improving medical care. Moreover, state governments have now allocated funds for expenses towards the telemedicine application in their states. And as part of the initiative, states have established a telemedicine network under which government medical colleges are connected to district headquarter hospitals with the intent to extend the speciality and super-speciality medical care for people residing in different districts. As a result, this telemedicine revolution in India has broadened from government sector to private sector to clinics. In long term, it will play a major role in improving the quality of medical care in India.

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One of the recent surveys suggest that there is a shortage of around 5 lakh doctors in India. Do you think telemedicine can replace doctors, especially in the rural areas? Yes, to some extent. There is a lack of specialists in every hospital. One of the ways to address the challenge of deficiency of specialists is the adoption of the wider application of telemedicine technology. With the assistance of telemedicine: Specialists working in medical facilities or medical college hospitals can offer advice to the nonspecialist doctors, medical staff and nurses in emergency. Prompt delivery of advice can be given to the patients of any region under the supervision of experienced medical personnel.

Based on the advice of the specialist, doctors with not much sophisticated infrastructure and advanced technologies can confidently take the responsibility of treating patients.

Today as per the trending telemedicine, not only small check-ups and regular checkups, but also major operations are being conducted on a regular basis. What major challenges and opportunities do you see in this? There are two ways to look into one of the parts of healthcare technology known as tele-presence surgery: Doctors working in different hospitals can operate with the guidance of experts sitting at superspeciality hospitals known as telemonitoring and have great

Telemedicine

prospects in the future. Other is telerobotic surgery which is yet to come up in the country, though robotic surgery has been started in the country. Interestingly, telementoring is something which aims to benefit a lot of medical professionals.

While implementing telemedicine services in the rural areas, a structured business model is an essential key or need. Do you feel this can lead to business efficiency and craft more opportunities? It has been witnessed that different state governments are actively taking initiatives and implementing telemedicine programmes in their regions, but are unable to reach a large number of masses. Additionally, all citizens of the country cannot avail benefits of telemedicine through government initiatives alone, which ultimately tend to create the need for private sectors, non-government organisations (NGOs), etc. These private sectors can take the responsibility of taking telemedicine to the common masses. As a result, business models will be required to strategise to support private partners and organisations to implement the telemedicine programmes. In India, there are lot many health associations, as well as authorities who are working for the growth of telemedicine. They are needed to seek and take initiative to develop business models for private partners. This proposal can help private partners to implement telemedicine technology while benefiting common men.

As rightly mentioned by you, government has a bigger role to play in the favour of its countrymen. However, in some areas, both private and government sectors must take few steps equally in favour

Key Takeaways • Most medical facilities are accepting telemedicine as a way of improving medical care. • State governments have now allocated funds for expenses towards the telemedicine application in their states. • States have established a telemedicine network under which government medical colleges are connected to district headquarter hospitals. • Private hospitals need to take the responsibility of taking telemedicine to the common masses. • Need to structure new business models for private sector based on public-private partnership (PPP) model of the public. In the light of the above, do you feel that private sectors must be open to execute services in the rural areas and they can take it as an opportunity for them? As such, equal participation of both government and private sectors is a process of transition. The government sector is actively looking towards telemedicine as an emerging opportunity. Now, the second step should be of involving public-private partnership (PPP), and it should be well known by the partners that the adoption of telemedicine as a service will also add value to their benefits. It’s only then one can move towards structuring a new business model for private party. Therefore, unless this process of transition moves, we cannot completely depend on the private sector to deliver the telemedicine service. Hence, we should allow it to move from government sector to PPP mode and then purely to private sector.

How you envision the future of telemedicine in India? It is clear that the future of medicine is telemedicine. The following measures are needed to ensure wider adoption of the technology telemedicine:

• Telemedicine is needed to grow in a wider way. • Government has to take responsibility to create its importance among citizens of the country. • Government has to make budgetary allocations towards telemedicine so that a particular medical technology can find more use in the healthcare delivery system.

Being the apex body in telemedicine in India, how is Telemedicine Society of India creating awareness among people to adopt it as a service? For its growth, Telemedicine Society of India organises: • Conferences • Workshops • Camps in different regions of the country every year through its states chapter • Conducts activities in different areas, rural areas and urban areas Moreover, more than the doctors, the paramedical workers should know the benefit of telemedicine, only then the common men will be able take the advantage of telemedicine. Additionally, media should come forward to make professionals, as well as the common men, aware about the benefits of telemedicine.

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Key Healthcare Initiatives

Realising Greatest Strengths of Healthcare via Collaboration, Not Competition Priya Yadav of Elets News Network (ENN) discusses in detail the ever-growing role of private players in the healthcare space. As a result of the active participation of private companies under the public-private partnership (PPP) model, Punjab has witnessed increased enhancement in the standard of healthcare services. With the objective to outsource healthcare services to private players where possible, Government of Punjab is actively collaborating with private companies to provide services, including infrastructure development, testing, screening facilities, etc.

rivate players in the health domain have come to the rescue of the government in a variety of areas, especially those where the government set-up has not been able to raise its standard of delivery of health services. The beneficiary has been the common man, who now has the advantage of getting better health services rather than relying on governmentâ&#x20AC;&#x2122;s notoriously poor health services. This is true not just in the remote and rural areas, but also in big cities where the

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government infrastructure in health sector falls far short of expectations. Even as the state governments are making attempts to strengthen their infrastructure, there is an increasing dependency on private hospitals and diagnostic centres, which are increasingly partnering with the state governments for providing effective healthcare to people across all sections.

Cashless Health Insurance Schemes Nearly a year ago, the Punjab

Government took a decision to implement cashless health insurance scheme in lieu of the policy of reimbursement of the medical expenses. This decision of the state cabinet came as a boon for over 6.5 lakh employees and pensioners of the state government. The facility of cashless treatment is now provided to government employees, pensioners and their dependents in more than 250 empanelled public and private hospitals in Punjab, Chandigarh and NCR (Delhi, Gurgaon and Noida).

Key Healthcare Initiatives

Under this scheme, all the benefits are granted to the employees according to Service Rules (Medical Attendance Rules 1940). The expenses on treatment if taken outside the state are reimbursed to the employees by the insurance company within 15 days of submission of medical claim. According to the scheme, the expenditure on treatment of patients admitted in hospital and 246 kinds of “day care” procedures, in which treatment is provided in less than 24 hours, and treatment of chronic diseases in an outpatient department (OPD) is provided to patients without spending any money. The OPD expenses other than those related to chronic diseases continue to be met through a fixed medical allowance. The scheme covers pre- and post-hospitalisation benefits up to 7 days and 30 days, respectively, which were not available under the prevailing rules. Though the insurance company cover was Rs 3 lakh per family; however, the scheme would cover a family for an unlimited amount. And, though the scheme was made compulsory to employees and pensioners, it was optional for All India Service Officers, serving and ex-MLAs, and serving and ex-Judges

Role of Private Players - Key Takeaways • Both Punjab & Haryana governments have come up with cashless health insurance schemes with a new empanelment policy inviting increased number of private players • Two cancer hospitals have come up in Mohali and Bathinda with the help of Max Healthcare • Private hospitals under the PPP model are giving 5% of the gross turnover every year to the Punjab Government • Private hospitals also extending state-of-the-art treatment to people • The Central Government is attracting private players for various healthcare projects running under NRHM • Private players already present in healthcare landscape with 70% medical colleges being private • PGIMER Chandigarh had joined hands with RAD-AID and Royal Philips Electronics limited and launched a 6-month pilot project under Asha Jyoti programme of Punjab and Haryana High Court. Following on the lines of the Punjab Government, the Haryana Government has recently approved the new empanelment policy of private hospitals under which medical reimbursement to the State Government employees, pensioners and their dependents will be allowed at Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, rates along with 75 per cent of the balance amount

is applicable to non-package procedures. Under the new policy, multispeciality hospitals with minimum 100 beds and superspeciality and single speciality hospitals having minimum bed strength of 30 will be eligible for empanelment. To be empanelled, a hospital must possess an accreditation certificate of National Accreditation Board for Hospitals & Healthcare Providers or Joint Commission International. The Government has after inspections notified the hospitals for empanelment that fulfilled the due criteria. Inspections were carried out by a Committee headed by Additional Director General Health Services or Director or Civil Surgeon as per the directions of the Director General Health Services with the specialists as members.

Public-Private Partnership (PPP) Private hospitals are actively participating in cashless health insurance schemes of Government of Punjab under the PPP model

In a state where cancer has spread like cancer, Punjab has relied massively on providing treatment through the PPP model. Two cancer

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Key Healthcare Initiatives

hospitals have come up, one in Mohali and another in Bathinda with the help of Max Healthcare. Even as the Government has provided land at concessional costs, the private hospitals have been set up which will also give 5 per cent of gross turnover every year to the Government besides providing state-of-the-art treatment to people. It is not just the state governments which are promoting partnership with private sector wherever possible, but also the Central Government which has come out with a policy on this. The idea is to outsource health services to private players where possible, thereby supplementing government funding with private investment and improving expenditure in the area. The framework developed is to attract private partners to run subcentres and primary health centres under the National Rural Health Mission (NRHM), provide diagnostic facilities where possible, train human resources in health, and build hospitals and infrastructure. Even hospital cleanliness and waste management can be outsourced. This is already happening in certain prime hospitals like PGIMER Chandigarh where services like security, cleanliness and host of other services have been outsourced. PPP models have been developed for NRHM services, medical education, human resource training and infrastructure augmentation.

Collaboration with private players is proving a boon for catering to all kind of healthcare issues

There is already private presence in the health sector with over 70 per cent medical colleges being private. Collaborating with private companies is proving to be a boon even when it comes to detecting diseases, not just in treating them. Region’s premier medical institute, PGIMER Chandigarh had joined hands with RAD-AID and Royal Philips Electronics limited and launched a 6-month pilot project under Asha Jyoti programme, where more than 500 women were screened for breast cancer, cervical cancer and osteoporosis in rural areas. In the project, nearly 50 per cent of the women seen were from the poorest socio-economic groups in India, living in households that earn less than Rs 60 per day, and the mobile unit provided an opportunity for free health screening on their doorstep.

Asha Jyoti - Overview Asha Jyoti is a population-based

PGIMER Chandigarh recently joined hands with RAD-AID and Royal Philips Electronics limited and launched a 6-month pilot project under Asha Jyoti programme where more than 500 women were screened for breast cancer, cervical cancer and osteoporosis in rural areas

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screening programme for women aged between 40 and 60 years. It aims to ensure early detection of breast cancer, cervical cancer and osteoporosis, even before the individual has any signs or symptoms. It was established as a model for preventive healthcare for semi-urban and rural areas in northern India and involved in the creation of a special mobile outreach van with imaging technology and clinical referral services to efficiently and effectively address multiple care needs. During the 6 month pilot phase, 615 women participated in the screening, and now that the programme is going into full “operational phase” the aim is to screen 2,000 to 3,000 women every year for at least the next 4 to 5 years and provide a clear plan for followup and further routine screening. In addition to being a model for integrating women’s health services, the collaboration is a unique public-private partnership between government (PGIMER) entities, non-profit non-government organisation (RAD-AID) and the private sector (Philips Healthcare). To make the Asha Jyoti programme work, PGIMER delivers the clinical services, RAD-AID is providing educational training and programme planning support to health workers and staff and Philips has donated all the equipment and also donated the entire van which was designed and built in India with local suppliers. Overall, it is interesting to note how both public and private sector players are together making a powerful impact on the healthcare space. Isolated actions are definitely not going to solve the problems or fill the gaps present in the Indian healthcare space where maintenance of quality and standards remains an issue and can only be resolved through the active participation of private players.

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Key Healthcare Initiatives

e-Mamta: Harnessing Benefits of ICT to Promote Institutional Delivery As creating an adequate data base has emerged as the key goal of both central and state governments, e-Mamta is playing a crucial role in the state of Gujarat in addressing the challenges related to lack of sufficient tools to maintain data on pregnant women due to which information related to both MMR and IMR remains largely unchecked despite posing a daunting challenge for an emerging country like India to ensure quality care & better services to all, Hemangini Rajput of Elets News Network (ENN)

he web-based software application e-Mamta covers nearly 84.4 per cent of the population of Gujarat. So far, the software possesses an organised database of about 1.18 crore families in all the 33 districts of Gujarat, covering about 5.51 crore individuals, the system generated unique health IDs, which have been provided to individual pregnant mothers, individual children within the age group 0 to 6 years and adolescents. This assures that complete services of antenatal care, child birth, postnatal care, immunisation, nutrition and adolescent services are extended to the target segment.

Work Plans The comprehensive Work Plans are versatile tools to the service providers at the grass-root level to determine the latent recipients of the services along with their details. Through e-Mamta, accurate reports and various analyses are segregated

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for further increasing the efficiency and utility for optimal public welfare through reports, health cards, nutrition chart, immunisation cards, pregnant woman Hb/wt chart and graphical analysis of various indicators

Complete Lifecycle Approach The e-Mamta system has passed on various critical benefits to the citizens of Gujarat. Through its ‘Complete Lifecycle Approach’, the system records the data from birth to

death of an individual. It incorporates work plans at the grass-root level for a clear understanding of the targeted beneficiaries. Through the provision of unique IDs (UIDs) to individuals, issues like migration/transfer in service delivery and duplication of registration of mothers is resolved. The system records every individual as one single unit, ruling out the possibilities of excluding even one person. e-Mamta application is implemented in four steps, namely

e-Mamta – Key Takeaways • Web-based software application covering nearly 84.4% of the Gujarat population • Includes an organised database of about 1.18 crore families in all the 33 districts of Gujarat • Records the data from birth to death of an individual through its ‘Complete Lifecycle Approach’ • Can resolve the issues like migration/transfer in service delivery & duplication of registration of mothers through the provision of unique IDs.

Key Healthcare Initiatives

family health survey, pregnant women and child registration, work plans to track due beneficiaries, service delivery and tracking of left outs. Work plans- the heart of e-Mamta, has been introduced for the first ever time where detailed schedule of due RCH service is prepared for each grass-root level workers. Use of work plans ensures that maternal and child health service reaches each pregnant woman and children in time, which in turn is critical in the reduction of infant and maternal mortality. The system enables member search on several parameters like name, name of village, ration card number, mobile number, health ID, family ID, bank account details, Rashtriya Swasthaya Bima Yojna card number, Below Poverty Line card number and UID.

role in promoting institutional delivery. ‘e-Mamta’ is innovative as it is intended to harness the benefits of information and communication technology (ICT) to improve effective and efficient delivery of healthcare services available. The programme has been designed to cover the entire

Operational Framework & Strategy PROGRAMME DESIGN • Key Stakeholder SERVICE

INTERMEDIATE LEVEL:District and LOCAL LEVEL Block :Doctors,health

SERVICE

e-Mamta (Mother and Child tracking System)

STATE LEVEL: H&FW Dept. and NIC

STATE LEVEL: INTERMEDIATE H&FW Dept. LEVEL:District and NIC and Block

PROVIDER PROVIDER

workers

LOCAL LEVEL :Doctors,health All eligible workerswomen pregnent

e-Mamta (Mother and Child tracking System)

(15-45 years)

All eligible pregnent women (15-45 years)

SERVICE RECIPIENTS

Objective High rates of maternal mortality rate (MMR) and infant mortality rate (IMR) are amongst the daunting challenges confronting public health in India. The total MMR rate of Gujarat according to the Sample Registration System for the year 2007-09 was 158 per 1,00,000 live births. The total IMR rate of Gujarat as per the Sample Registration System for the year 2008 was 50 per 1,000 live births. The State of Gujarat took a velocity in this and initiated ‘e-Mamta’, a ‘Mother and Child namebased information management system. It has played a noteworthy

state of Gujarat and specifically caters to rural and urban slum communities. The initiative was conceived by the State Rural Health Mission of the Health and Family Welfare Department, Gujarat in January 2010 and was implemented in May 2010.

Children(0-6)

SERVICE RECIPIENTS

Children(0-6)

Adoloscents(1019)

• Workflow

FAMILY FAMILY HEALTH HEALTH SURVEY SURVEY

REGISTRATION

WORK PLANS

WORK PLANS TO TRACK TO TRACK SERVICES SERVICES

MONITORING

MONITORING AND AND EVALUATION EVALUATION

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Key Healthcare Initiatives

Beneficiaries

Our Success Journey

• All pregnant women • All infant

Achievements Details regarding ANC registered, delivery registered and child registration from the year 2010-11 in e-Mamta is shown in the following table

Affirmative Impact of the Project on community • Use of work plans showing improved coverage in urban and semi urban areas, tracking of mothers made possible in hard to reach tribal areas. • Auto generated SMS are sent to ANC mothers and families of children for due ANC and vaccination services. SMS being sent from e-mamta to intradepartmental employees for better coordination.

E- Mamta Mothers & Child Tracking

Key Challenges • High rates of MMR and IMR are amongst the daunting challenges confronting public health in India

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Year

ANC Registration

Delivery Registration

Child Registration

2010-11

903,901

415,593

551,333

2011-12

1,170,095

780,354

841,249

2012-13

1,298,983

996,208

1,038,813

2013-14

1,332,095

1,116,097

1,138,723

2014-15

1,178,408

1,038,425

1,025,837

RECOGINITION/ AWARD Date

Achievements

January- 2010

e-Mamta conceptualisation and data entry modules developed

May-2010

e-Mamta project launched all over Gujarat

July-2010

Presentation in review meeting of NRHM in Bhopal and announced for national roll out.

August-2010

Training to state nodal officers & state data entry managers in four batches of all the state in Delhi & Gandhinagar.

December-2010

Recognised as the finalist in the 2010 for Manthan Award.

August-2011

e-World Award

September-2011

Diamond EDGE Award 2011

October-2011

India Tech Foundation Award 2011

February -2012

Outstanding Performance in Citizen-Centric Service Delivery-Silver award by Department of Administrative Reforms & Public Grievances GOI

February -2012

ICT-Led National Social Innovation Honor-Government Bodies By NASSCOM Foundation

February -2012

Successful Implementation of IT Projects in Government by GESIA

July 2012

One of the Finalists for mBillionth Award

Impact • The impact and attainment of the ‘e-Mamta’ inventiveness has been significant. It has been able to accelerate the process of effective and efficient delivery of health services to the people at grass root. • Institutional delivery rate in the state has increased from 77.8% in 2007-08 to 97.5% in 2014-15 • IMR in the state decreased from 50 in 2008 to 36 in 2013 (as per SRS) per 1,000 live births • MMR of the state decreased from 148 (2007-09) to 112 in 2011-13 (as per SRS) per one lakh live births • In the improvement of IMR, MMR and institutional deliveries rate in the state e-Mamta had played critical role through tracking of services

Electronic vaccine logistics system to improve vaccine coverage in Rajasthan The Ministry of Health and Family Welfare is currently rolling out an innovative electronic vaccine intelligence network called Electronic Vaccines Intelligence Network (eVIN )across all districts in Rajasthan. eVIN aims to support the Government of India’s Universal Immunization Programme by providing real-time information on vaccine stocks and flows, and storage temperatures across all cold chain points in Rajasthan. Beginning in October 2015, eVIN has been rolled out in 160 districts of Madhya Pradesh, Rajasthan and Uttar Pradesh. The technological innovation is implemented by the United Nations Development Programme (UNDP) with financial support from Gavi-The Vaccine Alliance. eVIN aims to strengthen the evidence base for improved policy-making in vaccine delivery, procurement and planning for new antigens in India, home to the world’s largest birth cohort of over 27 million.

Roll-out underway in states across India In addition to these states, eVIN is being rolled-out in 211 districts of Assam, Bihar, Chhattisgarh, Gujarat, Himachal Pradesh, Jharkhand, Manipur, Nagaland and Odisha. In doing so, eVIN will support better vaccine logistics management at more than 10,000 cold chain points reaching out to nearly 60 per cent of children under the age of two in the country.

Integrated solution to vaccine management eVIN provides an integrated solution to address widespread inequities in vaccine coverage by supporting state governments in overcoming constraints of infrastructure, monitoring and management information systems and human resources, often resulting in overstocking and stock-outs of vaccines in storage centres.

The integrated solution combines:  Technology: To facilitate evidence-based decision-making by making available online real-time information on vaccine stocks and storage temperature through the eVIN application software and temperature loggers;  Governance: To ensure efficient vaccine logistics management by systemizing record keeping through standardizing stock and distribution registers; identifying gaps and improving clarity on vaccine cold chain network; drawing attention to infrastructure upgrades; developing standard operating procedures and encouraging good practices;  Human Resources: To empower the state cold chain network by building the capacities of government cold chain handlers and deploying vaccine and cold chain managers in every district for constant support to estimate vaccine requirements, supervise cold chain handlers and coordinate with cold chain technicians across the district.

How does eVIN work? All cold chain handlers are provided smart phones with the eVIN application which allows for the digitisation of vaccine inventories. As a routine task, every cold chain handler enters the net utilization for each vaccine in the standardised registers at the end of every immunization day. This is simultaneously updated in the eVIN application and uploaded on a cloud server which can then be viewed by programme managers at district, state and national level through online dashboards. In addition to providing realtime information on vaccine stocks, the system also helps to track storage temperature of vaccines. SIM-enabled temperature loggers attached to the cold chain equipment capture temperature information through a digital sensor placed in the refrigerator. Temperature data is recorded every ten minutes and updated at an interval of sixty minutes on the server via General Packet Radio Service (GPRS). In case of temperature breach, the logger alarms and sends email and SMS alerts to responsible cold chain technicians and managers. eVIN empowers the cold chain handlers by building technical capacities and providing a robust decision-making tool for cold chain managers through a complete overview of vaccine replenishment times, supply and consumption patterns. By streamlining the vaccine flow network, eVIN is a powerful contribution to strengthening health systems and ensures equity through easy and timely availability of vaccines to all children.

eVIN in Rajasthan In Rajasthan, total 2,224 government staff including vaccine store-keepers and cold chain handlers have been trained on mobile and Web-based eVIN application through 95 batches of trainings at district level. As part of these trainings 2,224 smart phones given to cold chain handlers as well as vaccine store keepers and for temperature monitoring 2,274 temperature loggers have been installed in 43 vaccine stores and 2181 cold chain points in all 34 districts for accurate temperature review.

For more information: www.in.undp.org/evin

Key Healthcare Initiatives

Eram Scientific Solutions: Creating Smarter India via Bolder Ideas

With a constant scarcity of resources and manpower, eToilets can prove a boon to the Indian population and key catalyst for several government projects working on sanitation & hygiene, such as Swachh Bharat Abhiyan, across India. Created and customised after intensive R&D, these toilets are robust and long-lasting. Moreover, these toilets are playing a key role in addressing challenges related to spread of disease and ensuring appropriate facilities to women and young girls. In a very interesting conversation, Bincy Baby, Director, Eram Scientific Solutions, shares the reasons behind creating such an innovative solution.

The kind of services, such as electronic toilets, being offered by Eram Scientific Solutions (ESS) is very innovative and relevant both for the government and public. Therefore, we would like to know how you came across such a concept and idea? ESS was started by Dr Siddeek Ahmed, who is from Kerala and Chairman of the Eram Group. With his base in Saudi Arabia, he had been actively intervening in all social development activities of Kerala. Incidentally, he was also massively disturbed by the statistics that suggest that over 50 per cent of the Indian population still defecate in open. And, most of the kidney diseases among women are due to the lack of appropriate sanitation facilities. We identified that basically sustainability is the major issue and the kind of manpower support required for toilets. As such, lack of toilets is not the real problem in India, rather the stigma attached with the entire concept of toilet. In order to address healthcare challenges related to open defecation and remove the stigma attached to it, we ventured into public toilets. As such, household is altogether a

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Key Healthcare Initiatives

different sector for us. We came up with the idea to have a technology that can in some way address the inherent challenges in sanitation that include lack of manpower, spread of infection, conservation of water, etc. Compared to a normal toilet, we can programme the water usage and cleaning to allow the optimal use of resources and avoid any kind of infection.

What kind of technical measures have been undertaken to avoid any kind of spread of communicable diseases through such publically shared systems? Basically, all these toilets are designed in such a way that cleanliness is maintained throughout. Since it is cleaned through a self-automated system, the chances of spread of infection are almost negligible. Additionally, we have deputed a person to go and check the toilets at regular intervals. Unlike manually operated toilets, the electronic toilets are largely self-automated and all mechanisms have been integrated to avoid any kind of cleanliness or hygiene issues. Such toilets are really beneficial for women who due to socioeconomic changes are mostly mobile these days. They can access napkin incinerators and vending machines installed in electronic toilets. Such toilets can also solve the issue of increased absenteeism amongst girls in remote areas due to lack of appropriate sanitation facilities.

Definitely such a solution is needed in a country like India;

eToilets are not just easier to install, but also ensure adequate use of scarce resources and have proven to be a boon in remote areass

however, with such a large population and other challenges, what kind of roadblocks did you witness while campaigning for electronic toilets to policymakers and market players? It had been a very difficult path for us, though we have been in this field for the last 8 years and have introduced the concept of eToilets or electronic toilets.

Electronic Toilets – Key Takeaways • Allows optimal usage of resources, including water, and cleaning to avoid spread of infection. • Has negligible chances of spread of infection due to cleanliness maintained through a self-automated system. • Has also deputed a person to go and check the toilets at regular intervals. • Extremely beneficial to women

At a time when we have automation in almost all fields of our life, why not in sanitation. There need to be increased awareness that automation of pubic sanitation facilities is here to stay. The contention given by many people was that we do not need automation for something which is all about waste. This may be primarily due to the stigma attached with the concept of toilet. The waste can be the source of power for the community. With the great extent of innovation happening across the world on sanitation, India unfortunately still holds conventional beliefs regarding toilets. Therefore, it had been very difficult for us to change such an age-old thinking among people. Meanwhile, the Chennai Corporation, which is staging a lot of awareness on open defecation, conducted a study on our project and how it is different

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Key Healthcare Initiatives

eToilets are being installed across different schools in villages thereby decreasing absenteeism in schools

from conventional toilets on terms of payback. Interestingly, they came out with the finding that over the 5-year period the amount of money invested in conventional toilets is comparatively larger than what is invested in electronic toilets. Now, we have around more than 200 toilets running under the activities of the Chennai Corporation.

The entire concept of eToilet is close to Swachh Bharat Abhiyan. Please provide details how closely are you working with the government bodies. One significant project we did under Swachh Bharat Abhiyan was Corporate Social Responsibility (CSR) project for Tata Consultancy Services (TCS) Foundation. We installed 600 electronic toilets in Nellore district of Andhra Pradesh for a remote school where students have been using eToilets for the first time. Over 1 year now, the electronic toilets are still working perfectly fine. We also have the maintenance mechanism also integrated in the system. One advantage of electronic toilets is the

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ease of installation. They come in a pre-assembled condition and itâ&#x20AC;&#x2122;s only matter of transportation, fixing and connecting it to the utility supply. For mass deployment, this is a perfect product for sanitation. We are also working with Shell in Gujarat along with Surat Municipal Corporation. We are planning to do more such projects. We have not gone into an aggressive marketing strategy, but there has been good references from the authorities to other municipalities to use the eToilets as a solution to their long-standing public sanitation worries . It has worked well in Bengaluru, Chennia, Mumbai and Delhi. Now we are moving to Gujarat, Punjab and Maharashtra in a big way based on our understanding. In context of smart city, we can provide the government a connected electronic toilet infrastructure via web or mobile interface. This product gels with the Internet of Things (IoT) concept. This way we can understand how many people have accessed toilets, income generated from such a system, etc. We launched the school model at just Rs 1

lakh as part of our CSR.

As we all know that Indians are really particular about making investment in only durable products. How much durable are electronic toilets and how often do they require maintenance? Actually, electronic toilets are made of stainless steel, which is certified to last more than 20 years. The toilet as a structure has no problem both from the angle of robustness and structural integrity. The product will stand for a long time. It also has no issues like regular maintenance of tiles, etc.; we have to only ensure that the toilet has adequate water and power supply. We have a very dedicated team with a network of around 200 service providers across India who attend to the toilets. We ensure that the burden of maintenance is borne by us in a responsible manner. Where there is no power option, we connect toilets through solar supply. It had withstood the HudHud cyclone in Vizag and the worst floods of Chennai as a testimony of tis robustness.

Developed in the U.S. by Drexel University and iBreastExamTM - Portable, UE “Cancer screening is one of iBreastExamTM Portable, Hand-Held Device Hand-held Device for Early LifeSciences the priority sectors and cleared by for Early Detection of Breast Cancer identified in the review Detection of Breast Cancer

Breast Cancer has now surpassed cervical cancer Breast Cancer has now surpassed cervical cancer to become the leading cancer in Indian women. to become the leading cancer in Indian women. The growth incidencerate rateis ismost mostalarming: alarming: The growth in in incidence cases of breast cancer among women in Delhi, cases of breast cancer among women in Delhi, Mumbai, Chennai and Bengaluru increased Mumbai, and only Bangalore from 10 Chennai, per 100,000 about 10increased years ago from 10 per 100,000 only about 10 years ago to to approximately 25 per 100,000 now. 1.5 lakh approximately 25 per with 100,000 lac women are diagnosed breastnow. cancer1.5 in India each year this number willbreast only increase women are and diagnosed with cancer over in time.each Mostyear devastating of allnumber is that the India and this will average only age of diagnosis is under 50 (43 to 47), with increase over time. Most devastating of all is a sharp increase in prevalence in women in their that the average age of diagnosis is under 50 30s. With a survival rate of only approximately (43-47) with a sharp increase in prevalence in 50 per cent, India loses more women to breast women in their 30s. With a survival rate of only cancer than any other country. approximately 50%, India loses more women to breast cancer than any other country. Rajasthan State Health Minister, Rajendra Rathore was quoted in February 2016, “There Rajasthan State Health Minister, Rajendra are 2.5 lakh cancer patients in the (Rajasthan) Rathore was quoted in Feb 2016, “there are state and every year 40,000 new cases are 2.5 lac cancer patients in the [Rajasthan] added to the existing number of cancer state and every year 40,000 new cases are patients... among women, 27 per cent have added existing number of cancer breastto cancer.” patients... among women, 27% have breast cancer.” As the World Health Organization (WHO)

explains, low survival rates in less-developed countries are due to a lack of early detection As the W.H.O. explains, low survival rates in less programmes in concert with to a lack of adequate developed countries are due a lack of early diagnosis and treatment facilities. detection programs in concert with While a lack India of has some high-quality cancer treatment centres, adequate diagnosis and treatment facilities. it lacks a meaningful and robust screening While India has some high quality cancer programme that can help with cancer prevention treatment and early centers, detection.it lacks a meaningful and robust screening program that can help with Taking note, Prime Minsiter Narendra Modi cancer prevention and early detection. gave directive to the Ministry of Health and Family Welfare (MoHFW) in March to come up Taking note, PM Narendra Modi gave directive with a framework for a nationwide screening to programme the MoHFW March with and a for in cancers of to thecome breast,up cervix framework for a nationwide screening program mouth within 3 months. Subsequently, in June for 2016, cancers of the breast, cervix and mouth Health Minister Jagat Prakash Nadda within three months. Subsequently, in June unveiled a screening protocol in 100 districts for women above 30 years The unveiled need of the 2016, Health Minister J. of P. age. Nadda a hour, therefore, is for an innovative and portable screening protocol in 100 districts for women solution that can operated by India’s above 30 years of be age. The need of the existing hour, health infrastructure and provide clinically therefore, is for an innovative and portable effective, standardised breast health exams. solution that can be operated by India’s existing Developed in the United (US) by Drexel health infrastructure and States provide clinically University and UE LifeSciences and cleared by the US effective, standardized breast health exams.

the U.S. Food meeting. The PMO wants & Drug Food & Drug Administration (FDA), iBreastExam close coordination with the Administration is the perfect example of a high-tech Ministry of innovation AYUSH, (FDA), developed for the especially on the prevention “Cancer screening is iBreastExam is front,” emerging markets. a ministry source It is the world’s the perfect said. one of the priority first, ultra-portable, sectors identified in example of a high-tech innovation developed for the hand-held markets. deviceIt is emerging the review world's meeting. first, ultrafor early detection The PMO wants close portable, hand-held device for early detection of of breast cancer and coordination with the breast cancer and is Ministry an ideal of solution is an ideal solution AYUSH, for countries like India. palm-sized ondevice for countries like The especially thecan be operated anyone, even a health India. The by palmprevention front,”worker, a and the differences in sized works device by can identifying be ministry source said. operated by anyone, tissue elasticity between hard and stiff breast even a health worker, and works by identifying cancer tumors versus normal breast tissues. The the differences in tissue elasticity between iBreastExam test is completely painless hard and and stiff breast cancer tumours versus normal involves absolutely no radiation. For the first breast tissues. The iBreastExam test is completely time, any women above the age of 30 can be painless and involves absolutely no radiation. For prescribed a preventative breast health exam the first time, any women above the age of 30 can using iBreastExam. So far, over 15,000 be prescribed a preventative breast healthwomen exam using iBreastExam. So far, over 15,000 women have benefited from this test. On September 17, have benefited from this test. On September 2016, Medical Education Minister 17,of 2016, Medical Education Minister of Maharashtra Maharashtra announced a screening project to announced a screening project to benefit benefit 2.5 lac women across the state. 2.5 lac women across the state.

Key Healthcare Initiatives

Danvanthiri Medical Tourism Private Limited: Offering Single Platform to Access All Healthcare Services In an open conversation with Kusum Kumari of Elets News Network (ENN), Sivachenduran B, Co-founder & Managing Director, Danvanthiri Medical Tourism Private Limited, shares how Danvanthiri mobile app has been offering a one-stop solution by catering to all healthcare needs or services, ranging from ambulance service to data on organ donors. Through its innovative projects, addressing the challenge of lack of manpower in healthcare, it has been successfully training unemployed youngsters as patient coordinators to act as a local guide to patients. What were the reasons behind creating Danvanthiri and how it is different from other start-ups that are also offering a one-stop solution? From my early days, healthcare has been one of the most inspiring concepts for me. Around 4 years back, we started Danvanthiri, where we are catering in terms of medical tourism only to the

october / 2016 ehealth.eletsonline.com

Coimbatore people. We saw the potential of healthcare industry in the Indian market and also noticed that there is no big player catering to the complete healthcare market. In this way, we got the entire idea of starting Danvanthiri and started catering to healthcare services to almost every hospital of Coimbatore. We have almost every single hospital, doctors, pharmacies, labs and everything in our panel to provide complete healthcare solutions. During this process, we also explored different streams, to comprehend how technology can be leveraged in medical tourism. Almost 80,000 patients travel annually to India for medical treatment. We had facilities in the Middle East and Maldives and tie-ups with almost every single hospital in Malé, Maldives. We also had tie-ups with various healthcare organisations in different parts of world like the United States (US), Malaysia, etc. Based on these factors, we came to know that not every healthcare provider is catering to all segments of healthcare. We worked on providing a single platform to the end users to access all healthcare services and established Danvanthiri. Danvanthiri is on a mission to

grant a single window entry to access multiple choices on high-quality and affordable healthcare services across the globe. With the intent to offer a one-stop solution to avoid creating a junk of numerous apps, a 360 degree solution for healthcare, we have executed the following facilities: • Save Me Button: This is a global positioning system (GPS) enabled tracking system. Once you configure the app on your phone, you can reach nearby patient coordinator who will assist patient during emergencies with ambulance, first aid, etc. These services are built in the app. On top of that, we also have access to blood donors. • Organ Donor System: We are bringing in the organ donor facility. For this, we have already spoken to state and central governments for providing adequate provisions for enabling an organ donor facility. Under this system, people can request or list requirements for the needed organ or blood. • Ambulance Service: It is GPSenabled system which locates nearby ambulance services and can be hired on an urgent basis. • Medical Tourism: In case of travel requirements, flights, accommodations and travel plans

Key Healthcare Initiatives

can be booked. This service will be available in Phase II on our App and the work has already started to establish alliances. • Patient Coordinator: We have got a unique concept of patient coordinator. They are unemployed youth trained by Danvanthiri to become a patient coordinator to act as a local guide and provide healthcare assistance in a particular region.

What about the availability of Danvanthiri app and its operations? It will be available throughout India. At this point of time, data of 15 cities is uploaded right now on the app. It is operational only in south India and we are looking for funds for expansion across pan-India. Also, we have already given free listing service for doctors, pharmacies, labs and ambulances for 15 cities on the mobile app in our first phase. In the second phase after around 6 months, we will be introducing healthcare wearable to store all data in patients’ healthcare records. It will be sourcing that, doctors recommend required medical advice. This will be soon be integrated and launched in app. Danvanthiri aims to dominate IT healthcare in next 5 years.

How does this app work? What backend services are available for the same? We have a customer care centre, where in case of any emergency customers can contact us through a toll-free number and save me button facility. Process • When patients contact customer care, the executives get information of the patient, locate them and call the nearest available medical service provider who assists patient according to the requirement. • With the installed app, patients can avail medical services directly with just one click. • It is a purely configurable app

wherein customers install app, create log in id and access all the medical facilities through a single app. • This app is integrated with save me button which is linked to the nearest patient coordinator and provides notification to reach the nearest medical service provider. Interestingly, patients can configure contact numbers of their family members, doctors, members, clinics and pharmacies.

How are you collaborating for GPS-enabled services for ambulances? To establish GPS-enabled services in ambulances is an important topic and for implementation of the facility, we have been collaborating with government and private ambulance service providers. GPS-enabled services in ambulances will enable patients to locate the nearest ambulance. This service will be available in our phase II.

Do you come across any regulatory issue for single window access to blood and organ donor domain? We have regulatory issue in terms of organ donors but not in terms of blood donors system. In terms of organ donor process, the person has to register through Danvanthiri mobile app, then he/she goes through the needed government procedure and after confirmation the donor receives certificate directly from the government. Later we submit organ donor data to Tamil Nadu Organ Donation Organization and eradicate data. For gathering information on organ donors or for providing a platform to organ donors, we need to have valid permission and an authorisation letter from the government authority.

What kind of training modules is available for training patient coordinators? In

order

become

patient

coordinator, the candidates need to go through a procedure,such as submit valid documents, including educational certificates, residence proof, proof of identity, etc. After that, they need to submit the police clearance certificate,as well as provide two reference letters from some established people of their respective cities, such as professors, academicians, etc. A patient coordinator assists healthcare patients with the required healthcare needs and their charges differ from service to service.

Do you have any business plans to expand you services to tierIIIand tier-IV cities? Soon we will be launching our service in tier-I cities, including Mumbai, Delhi, Chennai, Kochi, Pune and Bengaluru. We will be expanding step by step from tier-I to tier-II and then to tier-III and tier-IV cities. Overall, we aim to launch our service in 200 cities,which will further connect to 200 cities. We believe in cluster approach and partnership approach as business models. We have signed various mutual agreements with top hospitals and healthcare service providers.

october / 2016 ehealth.eletsonline.com

Healthcare Recommendations

Galactic Medical DataBank: Implement Progress of Technology, Rather Than Falling Back to Old Technology Indian healthcare space can be strengthened by bringing it at par with the developed countries, such as the US and UK, in terms of healthcare policies, standards, technology and budgetary allocation. In an exclusive interview with Elets News Network (ENN), Krishnamurthy Ramalingam, CEO & MD, Galactic Medical DataBank Private Ltd, shares some of the key recommendations needed to address the challenges growing with time and increase in the number of healthcare providers. How is our Indian healthcare in terms of policies, budget, information technology (IT) & standards compared to other developed countries, such as the United States (US), Singapore, etc.? â&#x20AC;˘ Policies: Healthcare policies in the US are very well defined over the years which India can easily adapt to suit to its environment. The International Classification of Diseases, Tenth Edition (ICD10) is now default coding standard in the US, UK, Canada, Germany, China, France, South Africa and many major developed countries. Many health insurance companies mandate to use ICD-10 for the claim process too. â&#x20AC;˘ Budget: India spends 1 per cent of its GDP on public health compared to 2.4 per cent of its GDP on military expenditure. The US spends 17.1 per cent of its GDP on public health compared to 3.3 per cent of GDP on military expenditure; UK spends 9.1 per cent of its GDP on health compared to 1.9 per cent of GDP on military expenditure. However, it is very important to see that every rupee should efficiently reach the beneficiary and serve

october / 2016 ehealth.eletsonline.com

Healthcare Recommendations

its purpose curtailing corruption. • Information Technology (IT): The US, UK and other developed countries have almost 100 per cent healthcare IT in place where all the patient electronic health data is available on demand. In India, few states have taken initiatives to adapt and implement healthcare IT, but there are several states without much budget to implement healthcare IT. The Central Government’s financial help may help these states and Government of India owned specialised healthcare institutes. In the US, there is both federal and state health insurance exchange. • Standards: India can customise the available international standards on healthcare IT to suit its needs.

How can government promote start-ups in government projects and initiatives like Smart City, Digital India and Make in India campaigns? • The Indian government can keep it simple and easy for start-ups to register in Start-Up India initiatives along the lines of “Make it in Germany”. The idea should be to generate more employment. • The government can fund the startups to implement their products at government institutions and remove the typical prerequisites of strong financial background and performance for the past 3 years. • Government can help start-ups to tie-up with multi-national companies (MNCs) to participate in government projects & initiatives like Smart City, Digital India & Make in India. • Involve start-ups in policy-making for Start-Up India.

Cybersecurity is a matter of concern not just in the

Recommendations • Make health policies more well-defined like in the US • Increase the share of healthcare in the entire GDP • Strengthen healthcare IT initiatives through Central Government’s assistance • Fund start-ups to launch their products and work upon typical prerequisites less stringent • Involve start-ups in policy-making & government projects • Secure healthcare portals with strong encryption, antivirus software, etc. • Both on the premise and cloud based technology can be synchronised at regular intervals banking & finance sector, but also in the healthcare sector due to the availability of a huge amount of data. Can you please share your opinion about cybersecurity for healthcare and in general in India? Healthcare portals should be secured with strong encryption; implementation of international healthcare compliances; secured websites, mobile, laptop, tablet; etc., with antivirus software enabled. For more tips on cyber security in healthcare, go through the website https://www.healthit.gov/ sites/default/files/Top_10_Tips_for_ Cybersecurity.pdf

In the absence of Internet connectivity throughout India, how can cloud as a technology play the crucial role in delivering quality care even in the remotest parts of the country? India needs to work towards providing Internet connectivity even to the remotest parts of the country and many private vendors are actively involved to make it possible. Hence, we should work towards the progress of technology rather than falling back to old technology. However, we need to

have a solution which is both on the premise and cloud based which can be synchronised at regular intervals.

How can Government adopt public-private partnership (PPP) in healthcare delivery in India? To make an effective and efficient healthcare delivery system, our country needs to have publicprivate partnership (PPP) with nongovernment organisations (NGOs) and not-for-profit organisations, so that micro-management of these organisations helps to resolve the shortage of doctors, nurse, technicians, drugs and biomedical equipment. Regular monthly online submission of reports and dispersal of money helps these private organisations to sustain and deliver effectively. During our recent visit to Meghalaya, we observed how an NGO is efficiently managing remote primary health centres (PHCs) with both allopathic and Ayurveda, Yoga, Unani, Siddha, & Homeopathy (India) (AYUSH) mode of treatment. AYUSH should be introduced at primary, secondary & tertiary healthcare centres too. Developed Countries like US and UK are also promoting preventive healthcare using yoga and meditation.

october / 2016 ehealth.eletsonline.com

Understanding Emotional Health

ePsyclinic: Offering Counselling by Identifying Unique Problems In an exclusive interview with Elets News Network (ENN), Shipra Dawar, Founder, ePsyclinic.com shares how ePsyclinic has been removing stigma attached to mental diseases and assisting both patients and service providers. ePsyclinic empowers patients to choose the right therapist and treatment to make informed and relevant choice. Please guide us how ePsyclinic as an online platform for emotional health operates. How challenging the journey has been so far? Please provide details. ePsyclinic is India’s leading online and tele platform for seeking mental and emotional health services. From 47 sessions a month due to high stigma, lack of trust on online channels to 200 sessions a day, we have come a long way and worked really hard to break the taboo for seeing mental health. ePsyclinic not only worked on the patient side to remove stigma and increase acceptability, it also worked on the provider side to help them drop some of their own biases and also train them extensively in the online talk form of therapy.

What selection procedures are followed by ePsyclinic while considering a consultant and therapist for online consultations? What major factors do you think need to be particularly kept in mind during the selection? Selection procedure is both guided and self-driven. ePsyclinic has 18x7 live chat capability with guidance from psychologists who help a patient choose the right therapist or treatment provider for them based on their needs. Additionally, if a person wants to selfselect, the providers are listed by the issues and life problems they deal with, thereby making it much easier for the person to make an informed and relevant choice.

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Please walk us through your online modules and how they cover different aspects of relationships and life. What kind of research and development (R&D) is involved in the designing of the ePsyclinic modules? We deal with all mental health and emotional health issues across different age groups. The key health issues are depression, anxiety, couple counselling, senior wellness counselling, kids counselling, pregnancy counselling and psychological issues counselling. These have been designed after the research team has looked into their unique problems, issues and nuances, and the clinical team and development team have then designed solutions around that.

We would like to understand how these digital exercises boost up the self-esteem of the users suffering from emotional crisis. Talk therapy at ePsyclinic is designed

to perfection, keeping the unique needs, motivations, pain and sufferings of an Indian in view. Talk-led therapy is one of the best ways to curb emotional and mental health disorders. Talk therapy allows one to speak about self and selfneeds, sufferings and wants in a nonbiased, professional, active listening setting. The freedom to be in touch with one’s own thoughts, make sense of them and working in a systemic and systematic fashion helps reduce the stress manifold, thereby increasing the self-confidence and self-esteem of the person.

With rapid changes in the socioeconomic factors, do you think we are likely to see newer dimensions of mental diseases? If yes, please suggest what kinds of newer challenges have come up in our society and relationships? The world has become wired, too connected. Instantaneous responses are expected from a person, irrespective of the fact where he/she is. The boundaries between professional work time and personal space are blurring. This has led to a rise in tremendous stress, family discord and chronic fatigue experiences. With this the society is becoming much more individualistic where the perception of what is right comes from ‘Me’ as opposed to ‘We’. So going forward, individual stress issues and anxiety disorders will grow at an exponential rate, thereby needing focus of the mental health service providers and drug development companies.

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Technological Interventions

Wockhardt Hospitals: Ensuring Fast & Easy Access to Healthcare Services Wockhardt Hospitals has been not only adopting latest technologies, but also establishing an environment allowing experimentation and customisation according to the needs of the hospital and location. With the main focus on clinical aspect of medical care, it has been intelligently enhancing HIS and other technological tools. It aims to create a true patient-centric setting through the digitisation of different operations and departments to enable easy access to services. In a very open conversation, Sumit Singh, CIO, Wockhardt Hospitals, shares his vision and passion towards role of technology with Kusum Kumari of Elets News Networks (ENN)

Please walk us through the kind of state-of-the-art & high-end technological interventions being undertaken at different centres of Wockhardt Hospitals? Please provide details. About 5 years ago, I joined Wockhardt Hospitals with literally no background in the healthcare industry. Prior to Wockhardt Hospitals, I was working in one of the big four accounting firms in the United States (US). One of the key reasons for joining Wockhardt Hospitals was that it was moving into a direction that I wanted to be part of. I wanted to help make a radical shift in technology in the medical care field in the best way I could. At that time, what was up in the horizon at Wockhardt Hospitals was that we were in the process of building up our flagship 330-bed hospital that came up about 2 years ago in the South Mumbai area. That was the reason to channelise numerous changes in the entire Wockhardt Group. As of today, we have in total nine

october / 2016 ehealth.eletsonline.com

Technological Interventions

hospitals in Maharashtra, Gujarat and Goa. Since the time I have joined Wockhardt Hospitals, two large hospitals have been started in Mumbai. Since the beginning, we have focused on clinical care and clinical excellence. At the time of my joining, all the hospitals of Wockhardt Group were isolated in terms of their operations and disconnected from the IT perspective. Therefore, we decided to go for a new hospital information system (HIS) about 4 years ago. In order to choose the HIS according to our needs, we did extensive search, including global and Indian service providers. For this, we ultimately chose Wipro, which is also our existing vendor for the past decade. We had to work together with them to enhance the HIS, as we believe an HIS cannot be merely about ensuring appointments and other regular activities. These enhancements were in line with the fact that in the Indian context, the provision of handling the clinical aspect by HIS and other digital solutions was quite behind to the west. The primary reason behind the above is the existing mindset. The core thing we did was to enhance first of all our clinical areas to the extent that each and every operation is digital to ensure efficiency. Moreover, we integrated other features with the HIS system. For example, we went for an intensive care unit (ICU) system by Philips. In fact, we were the first or second hospital in the country to have that system across all our 100 ICU beds to directly collect realtime information related to patients’ parameters. For this, we made the entire hospital Wi-Fi so that no important information is missed when patients move in different areas. To run an HIS in a hospital, we have standard operating procedures (SOPs) to run the operations and processes

Wockhardt Hospitals has customised HIS to integrate more services than merely appointment booking

Key Takeaways • Has in total nine hospitals in Maharashtra, Gujarat and Goa • Main focus on clinical care & clinical excellence • Has made major enhancements in the existing HIS from the clinical perspective • Has created Workstation on Wheels, also called Computer on Wheels (COW), which was selffabricated after three to four tries to register all information related to medication and treatment efficiently. We have created Workstation on Wheels, also called Computer on Wheels (COW), which was self-fabricated after three to four tries to register all information related to medication and treatment not only in the ICUs, but also in the wards. We constantly endeavour to improve facilities located in different areas.

When it comes to the management of the hospital, which starts from the reception, what kind of technologies have been adopted by Wockhardt Hospitals to address challenges related to waiting time and patient experience? In order to ensure fast and easy access to our services, we have

invested in the mobility space. We have created our own product by guiding a competent mobility vendor chosen by us. We have created a separate mobile application related to hospital management. One of the few measures undertaken by us is that whenever a patient comes to the hospital, we provide them a tablet to capture all the relevant data along with digital signature directly and conveniently. We have kept the entire system very simple. Once the data has been captured and saved, patients are asked to come to respective counters for verification of captured data and also to make any corrections by the customer executive. The patients are also issued cards with bar codes and all relevant information for

october / 2016 ehealth.eletsonline.com

Technological Interventions

Wockhardt Hospitals has enabled Wi-Fi across all areas

hassle-free service in the hospital. Such a system allows easy access of exhaustive information by our associates. We have witnessed increased satisfaction from the patient side, as well as enhancement in efficiency. With the Wi-Fi in the entire building, such entry of information can be done from anywhere. We also have interfaces that allow patients to see diagnostic test results online. Basically, we have designed our website 2 years ago in such a way that it is mobile-friendly. Currently, we are in the process of creating a mobile application. We will collaborate with the vendor with technical capabilities, but the underlining feature of such a feature should be integrated with our own information system in order to ensure data and patient privacy.

What were the regulatory challenges in terms of enhancement of infrastructure?

october / 2016 ehealth.eletsonline.com

Please provide details. As such, the frameworks provided by the regulatory agency are quite wise and allow us to mostly accomplish what we want to do. Itâ&#x20AC;&#x2122;s only under certain times when we find ourselves in difficult propositions and conflicts, which is however quite rare. I am more focused on how regulation is able to allow an environment for critical analyses and innovations happening in the market in a much faster way. Digitisation is supported in a conscious manner through changes in the thought process of the regulatory process. I would also like to suggest that the regulatory bodies need to focus on the standardisation of the entire lifecycle of healthcare to ensure more efficiency.

We have lately seen a spike in the number of casualties due to accidents mainly due to infrastructural challenges in the tier-I and tier-II cities. In what

ways is Wockhardt Hospital addressing this challenge to provide right treatment and technology in the ambulance itself? About 3 years ago, we launched our own mobile van, which is actually about a 24-feet Volvo kind of bus partitioned into three separate chambers. It includes a lab and other medical facilities, such as electrocardiography (ECG) machines, etc. Other equipment can be included after checks and balances by the Government of India. It is staffed by a doctor and a couple of nurses, along with a specialist, if needed. With 4G around, realtime monitoring is much easier now than before. It is still running successfully. It is like an outpatient department (OPD) on wheels with competent doctors doing not just first-aid but also others tests. This model is little expensive, but can be implemented across India.

We are helping improve human and environmental health. PerkinElmer is a global leader focused on improving the health and safety of people and the environment. Our dedicated team of 8000 employees worldwide are committed to providing the technologies and expertise needed for scientists and researchers, enabling them to gain critical insights and discoveries in environmental monitoring, food quality & nutrition, pharmaceutical development & manufacturing, lifesciences & diagnostics.

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