Express Healthcare (Vol.12, No. 9) September, 2018

VOL.12 NO 9 PAGES 64

Strategy The boat of life Knowledge Dr Geetha Manjunath, CEO & CTO, NIRAMAI www.expresshealthcare.in SEPTEMBER 2018, `50

Smaller.

Smarter.

Simpler.

CONTENTS Vol 12. No 9, September 2018 Chairman of the Board Viveck Goenka Sr. Vice President-BPD Neil Viegas Asst. Vice President-BPD Harit Mohanty Editor Viveka Roychowdhury* BUREAUS Mumbai Usha Sharma, Raelene Kambli, Lakshmipriya Nair, Sanjiv Das,

Pg 22

Swati Rana, Tanuvi Joe

Delhi Prathiba Raju Design Asst. Art Director Pravin Temble Chief Designer Prasad Tate Senior Designer Rekha Bisht

STRATEGY

MARKET

OPINION

TRADE AND TRENDS

Graphics Designer Gauri Deorukhkar Artists Rakesh Sharma Digital Team Viraj Mehta (Head of Internet) Dhaval Das (Web Developer)

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Photo Editor Sandeep Patil MARKETING Douglas Menezes, Sunil kumar Debnarayan Dutta Ajanta Sengupta E Mujahid PRODUCTION General Manager BR Tipnis Manager Bhadresh Valia Scheduling & Coordination Santosh Lokare

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SUDHIR BAHL CEO, Milann – The Fertility Centre

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4TH EDITION OF HEALTHCARE SABHA TO BE HELD IN NEW DELHI

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29 STATES AND UTS SIGN MOU FOR IMPLEMENTATION OF AB-PMJAY

MK CHATTOPADHYAY, RETIRED SENIOR PRINCIPAL SCIENTIST, CENTRE FOR CELLULAR AND MOLECULAR BIOLOGY (CSIR)

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TIM MORRIS, Products and Partnership Director, Elsevier

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DR MONASHIS SAHU FELLOW, AMERICAN COLLEGE OF ENDOCRINOLOGY

KNOWLEDGE

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The boat of life

Express Healthcare® Regd. With RNI No.MAHENG/2007/22045. Postal Regd.No.MCS/162/2016-18. Printed and Published by Vaidehi Thakar on behalf of The Indian Express (P) Limited and Printed at The Indian Express Press, Plot No.EL-208, TTC Industrial Area, Mahape, Navi Mumbai-400710 and Published at Express Towers,

CIRCULATION Circulation Team Mohan Varadkar

Nariman Point, Mumbai 400021. Editor: Viveka Roychowdhury.* (Editorial & Administrative Offices: Express Towers, 1st floor, Nariman Point, Mumbai 400021) * Responsible for selection of news under the PRB Act. Copyright © 2017. The Indian Express (P) Ltd. All rights reserved throughout the world. Reproduction in any manner, electronic or otherwise, in whole or in part, without prior written permission is prohibited.

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EDITOR’S NOTE

Lessons from the past

A

recently released performance audit by the Comptroller and Auditor General (CAG) of India of the Pradhan Mantri Swasthya Suraksha Yojana (PMSSY) has many learnings for Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY).

Unfortunately, irregularities pointed out in a 2013 CAG report of the PMSSY have been repeated in the 2018 report as well, which means that there was no corrective action. The current performance audit covering from 2003-04 to 2016-17, found that the six new AIIMS had a cost overrun of `2,928 crores, and a time overrun of about four to five years in various packages. A shortage of faculty posts in different AIIMS, ranging from 55 per cent to 83 per cent, combined with a shortage of non-faculty posts (from 77 per cent to 97 per cent) meant that six to 14 speciality, super-speciality and other departments of 42 departments in these new AIIMS remained nonfunctional. The six new AIIMS were holding an unutilised balance of funds of `1,267.41 crore while `393.53 crores for civil works and `437.28 crores for procurement of equipment lay unspent with the executing agencies.

For patients, the intended beneficiaries of this scheme, the lack of faculty and non functional equipment etc meant shortages of beds ranging between 43 per cent and 84 per cent. Thus the CAG report points out that almost 15 years after PMSSY was announced and a significant spend on the institutions, these institutions had failed to deliver as per the original plan.

With the first phase of AB-PMJAY set to roll out on September 25 in 12 states and two union territories, the latest CAG report is a harsh reality check. As of early September, a total of 29 states and UTs have signed the MoU and have started work on the implementation of the AB-PMJAY, so a nation-wide consensus is slowing by surely building up. Will Prime Minister Modi's personal supervision of this scheme, often referred to as Modicare, ensure that the implementation is glitch free?

More importantly, even as no one doubts the need for such a scheme, does it have the checks and balances to detect frauds, leakages, false beneficiaries, etc? Thus, AB-PMJAY needs to be measured against each finding of the CAG report on the PMSSY so that any gaps are plugged as early as possible, ideally before the launch of the scheme.

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The CAG report reveals that while PMSSYwas well funded,managing and monitoring the funds were the weak links.

Will it be the same for AB-PMJAY?

Firstly, has adequate planning gone into AB-PMJAY? In the case of the PMSSY, it was a case of the old adage, haste makes waste. A preliminary feasibility assessment in March 2006 grossly under assessed several factors. Four crucial years were lost getting revised assessments and fresh approvals. The capital cost for the six new AIIMS for Phase-I escalated by 145 per cent in these four years, from `1,992 crores in March 2006 (estimated capital cost for each new AIIMS being `332 crores) to `4,920 crores in March 2010 (at the rate of `820 crores per new AIIMS).

The CAG report also points out that as the Ministry of Health & Family Welfare had not formulated any operational guidelines for PMSSY, implementation was guided by instructions issued from time to time resulting in several ad hoc decisions. Many critics are saying the same of AB-PMJAY, linking its launch this year to the general elections next year. Of course, this is being vigorously countered. Anti-fraud guidelines and a Data Privacy and Information Security Policy were launched recently. Shri JP Nadda, Union Minister for Health and Family Welfare has stated that the information security system has more than 94 controls set at various levels for secure handling of sensitive personal data. He has already reportedly cracked down on fake websites masquerading as the AB-PMJAY. Secondly, funding does not guarantee success.

The 2018 CAG report points out that while PMSSY was adequately funded, managing and monitoring were the weakest links. The CAG report specifically pulls up the national, state and institute level monitoring committees which were formed to review project implementation, saying that they remained ineffective. This is where the technology backbone of the Ayushman BharatPMJAY will hopefully play a vital role in tracking and monitoring the implementation of the scheme.

India desperately needs a health safety net and AB-PMJAY is definitely a step in that direction.

While PM Modi's government has launched many initiatives in the past four years, the Indian electorate will judge them on this one scheme.

Will the PM's vision translate into reality for the targeted 10 crore households?

VIVEKA ROYCHOWDHURY Editor viveka.r@expressindia.com

MARKET I N T E R V I E W

‘The infertility service market in India is undergoing a major change’ Milann has been in the forefront of advocating on the causes and precautions to be undertaken to curb the incidence of infertility. Sudhir Bahl, CEO, Milann – The Fertility Centre, reveals more in an interaction with Sanjiv Das

Infertility is a major issue in the country.

What has been Milaan’s contribution in curbing the incidence?

Infertility is caused due to the lack of certain hormones both in men and women, as well as due to changing lifestyles and other hereditary reasons are attributed to the cause. Recognising the need to address infertility with utmost precision and care, there has to be a certain amount of understanding that goes into it. Milann has been in the forefront of advocating on the causes and precautions to be undertaken to curb the incidence. Following healthy diet and active lifestyle, avoid smoking, checking the BMI periodically, timely screening for infertility are few aspects to be gauged to improve and maintain fertility status. Milann offers comprehensive healthcare services to women, right from awareness, educating women on risk factors to encompassing pre-pregnancy planning, pregnancy and post-delivery.

Since its inception in 1989, Milann has constantly been at the forefront in the application of cutting-edge technology like ICSI, embryo freezing, surgical sperm retrieval, embryo biopsy, laser assisted hatching and blastocyst transfer to ensure best possible outcomes of infertility treatment. Among the early contributions to the field, Milann achieved milestones in the infertility sector by establishing South India‘s first Semen Bank, delivering India’s

First SIFT Baby and South India’s first babies born through ICSI (Intra Cytoplasmic Sperm Injection) as well as through Laser Assisted Hatching.

You have centres in Delhi, Chandigarh, Mumbai and Ahmedabad. Are there any plans to open more centres?

Milann has been recognised as the No 1 fertility centre in the country, we continue our expansion and look forward to attain a significant market share in the NCR region and Western India. Simultaneously, efforts are to establish footprint internationally, especially catering to regions like in Middle East and South East Asia to narrow the gap in the infertility healthcare sector.

Infertility is a costly affair in India. How are you working towards to bring down the cost to ensure that the access increases?

The infertility services market in India is undergoing a major change and cost of treatment is definitely not an accurate measure of high quality services. Milann provides high quality and ethical services for which we have one of the best infrastructures in hands with expert clinical team with decades of holistic experience in the field. The focus remains on the superior clinical outcomes through research, innovation and advancement in procedures and a being price sensitive

We continue our expansion and look forward to attain a significant market share in the NCR region and Western India

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service sector, we believe in competitive pricing which comes at par with expertise and technology. To ensure that more couples have access to fertility solutions we are advocating and also spearheading the need for insurance cover in this sector.

to be known as ‘the most preferred reproductive medicine company for patients seeking solutions to infertility’ across geographies. We have one of the best clinical team in India led by Dr Kamini Rao and we

plan grow significantly to emerge as the national leader in this segment. The plan is to invest over $30 million in this business over the next few years. We will be in the best shape to provide further details towards the end of

this quarter.

awareness drives on infertility issues, screening programmes, life style modification programme and also region wise impact through education and research. sanjiv.das@expressindia.com

Tell us more about your CSR activities.

As part of our CSR initiatives, Milann has opened outreach centres in districts, conducts

What type of innovations are you looking for to help couples suffering from infertility?

Milann is on the forefront of using innovative technologies and clinical protocols to support couples suffering from infertility.

Apart from infertility management, Milann provides high-risk obstetrics treatment, gynae endoscopy, third party reproduction, prenatal diagnostic services and offer specialty clinics.

We have an academic

Efforts are to establish footprint internationally, especially catering to regions like in Middle East and South East Asia

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Milann has research collaboration with international companies which provides us access to latest technology to improve patient outcomes.

What is Milann’s growth plan for the next few years?

Tell us more about your investment plans. How much does this business contribute to their overall healthcare business?

There is no second thought on the fact that Milann wants

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September 2018

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MARKET PRE EVENTS

4 edition of Healthcare Sabha to be held in New Delhi th

The event from October 5-6, 2018, will bring together a think tank of policy experts, public health officials, and other key stakeholders to discuss and deliberate on issues pertaining to healthcare and come up with innovative strategies/solutions AS INDIA’S Public health Ecosystem rolls out Ayushman Bharat, the National Health Protection Mission (AB-NHPM), the Fourth Edition of Healthcare Sabha, invites Public Health Leaders to meet, deliberate and share their vision for 'Building The DNA For A Healthier Nation'.

Healthcare Sabha's 4th edition, organised by Express Healthcare, a publication of the Indian Express Group, will bring together a think tank of policy experts, public health officials, and other key stakeholders to discuss and deliberate on these issues and come up with innovative strategies/solutions as the nation gears up for the most transformational moment in its public health journey.

Thus, with public health elevated as the foremost national priority, Healthcare Sabha's 4th

best? ◗ New Age, New realities: The changing dynamics and priorities of Public Healthcare and methods to deal with it

Delegates profile will include the following:

edition will focus on three core areas: Health economics, equity and efficiency. Public health stalwarts will highlight the role of ethical practices in protecting patients of all socio-economic backgrounds.

Key topics to be discussed are: ◗ Health Economics, Equity and

Efficiency: Where does India stand? ◗ Strategies for capacity building in public health ◗ PPPs in healthcare: How can we strike the right balance? ◗ Ramping up health promotion: Dealing with India's dual disease burden ◗ State Health Financing v/s Central Insurance: What works

◗ Secretary, Addl. Secretary, Jt. Secretary, DG, DDG etc from Ministry of Health & Family Welfare, Government of India & various State Government ◗ NHM Mission Directors of various States ◗ NHM Policy Makers and Planning Officials ◗ Dignitaries from Central Drugs Standard Control Organisation (DCGI, Jt. Drugs Controller, Deputy Drugs Controller) ◗ Key dignitaries from NHSRC/SHSRC, NIHFW ◗ Dignitaries from State Health Corporations, State Health Society and State Health Mission

Director ◗ Director, Deputy Director of autonomous institutions like AIIMS, JIPMER, PGIMER, NIMHANS etc. ◗ Dignitaries from ESIC (Director General, Medical Commisioners, Deputy Medical Commisioners) ◗ DG - AFMS, Addl. DG-AFMS ◗ DG, ED, Director, Deputy Director - Railway Health Services, CMOs of various railway zones ◗ Chief Procurement Officer, medical superintendents, administrative heads of premier government and municipal hospitals from various states and cities To be held concurrently with Healthcare Sabha, the Express Public Health Awards will honour Champions, Visionaries and Game Changers in Public Healthcare.

RSNA to be held in Chicago from November 25 to 30, 2018 More than 50,000 attendees from around the world are likely to participate in the event THE 104 TH Scientific Assembly & Annual Meeting of the Radiological Society of North America, which hosts more than 50,000 attendees from around the world, will be held in Chicago from November 25 to 30, 2018.

Highlights from the meeting include: ◗ Breaking news from more than a dozen featured study presentations, and approximately 3,000 scientific presentations and posters cover-

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ing the latest trends in imaging research on important topics like Alzheimer's disease, stroke, breast cancer, heart disease, concussion, artificial intelligence and more. ◗ Opportunities to interview experts in all radiologic subspecialties and related fields. ◗ Access to approximately 2,000 education exhibits and informatics demonstrations.

The Radiological Society of North America (RSNA) is an international society of radiologists, medical physicists and

RSNA is an international society of radiologists, medical physicists and other medical professionals

other medical professionals with more than 54,000 members from 136 countries across the globe. RSNA hosts the world’s premier radiology forum, drawing approximately 55,000 attendees annually to McCormick Place in Chicago, and publishes two top peer-reviewed journals: Radiology, the highest-impact scientific journal in the field, and RadioGraphics, the only journal dedicated to continuing education in radiology.

Through its educational re-

sources, RSNA provides hundreds of thousands of continuing education credits toward physicians' maintenance of certification—more than one million CME certificates have been awarded since 2000. The Society also develops and offers informatics-based software solutions in support of a universal electronic health record, sponsors research to advance quantitative imaging biomarkers, and conducts outreach to enhance education in developing nations.

MARKET NEWS

29 states and UTs sign MoU for implementation of AB-PMJAY AT THE recently held press conference on Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) in New Delhi, Union Minister for Health and Family Welfare, JP Nadda, mentioned that 29 states and UTs have signed the MoU and have started working on implementation of the PMJAY. The pilots have started in 16 states / UTs. Other states/UTs will also start pilots before fully launching the scheme on September 25. Ashwini Kumar Choubey and Anupriya Patel, Ministers of State for Health and Family Welfare along with Indu Bhushan, CEO, AB-NHA were also present at the press conference.

Nadda cautioned that strict action will be taken against those running the fake websites on Ayushman Bharat. He categorically clarified that no enrolment is required for beneficiaries and there is no payment for obtaining services at empanelled hospitals. “Criminal cases will be charged against fraudulent websites and agents trying to collect money from beneficiaries,” he added.

Nadda stated that Arogya Mitras training is being conducted in collaboration with National Skill Development Corporation (NSDC) and Ministry of Skill Development to strengthen implementation and operational preparedness.

“Training has already been initiated in 15 states/UTs,” Nadda said. Reiterating the commitment of his government, the Union Health Minister said the objectives of the AB-PMJAY is to reduce out of pocket hospitalisation expenses, fulfil unmet needs and improve access of identified families to quality inpatient care and day care surgeries.

“The services will include more than 1300 procedures covering pre and post hospitalisation, diagnostics, medicines etc., and the beneficiaries will be able to move across borders and access services across the country through the provider network seamlessly,” Nadda

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stated.

Nadda also unveiled the PMJAY logo to the media while Patel, Minister of State for Health and Family Welfare launched the anti-fraud guidelines. Choubey

launched the Data Privacy and Information Security Policy.

Nadda and Dharmendra Pradhan, Minister of Petroleum & Natural Gas and Skill Development and Entrepreneurship

presided over a MoU signing ceremony between National Health Agency (NHA) and National Skill Development Corporation (NSDC) for skilling 1 lakh Arogya Mitras. Choubey

and Patel, Ministers of State for Health and Family Welfare were also present at the ceremony. Bhushan Manish Kumar, MD and CEO, NSDC signed and exchanged the MoU.

STRATEGY

The boat of life 15 boats sail through 2,500 river islands that dot the banks of the mighty Brahmaputra spreading hope and health for around 2.5 million people who had no access to basic healthcare. The success of Assam’s boat clinics is therefore a case in point for unfailing will, meticulous planning, coherent system and succesful medical outcomes. By Raelene Kambli

I

nitiating a public health programme is one thing, running it successfully is another thing and sustaining and scaling the successful model is an entirely different thing. While the former requires a vision, will and a meticulous plan, the latter requires passion, commitment, continuous effort to overcome road blocks and positive measurable outcomes. Assam’s boat

PATIENT TESTIMONIAL

Assam's boat clinics initiative- is a classic example of a well intended healthcare initiative that has been successful Ashok Rao, Program Manager, C-NES, Guwahati.

clinics initiative is a classic example of a well intended healthcare initiative that has been successfully implemented and scaled. It has now been a model which can be replicated in similar terrains.

The beginning of hope The Great Brahmaputra, one of the major rivers in Asia which flows through India, China and Bangladesh has around 2,500 riverine islands spread across the state of Assam with over 2.5 million people living in these islands, nearly 80 per cent of whom are poor. This represents eight per cent of the total population living in and around the region. The ‘Char Chapori’ (an area of Brahmaputra river and its

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Camp at Dibrugarh

tributaries in Assam) have one of the highest infant and maternal mortality rates in the state. In the absence of emergency medical services, it takes four to six hours

for a patient from a ‘Char Chapori’ to reach a district hospital for treatment. As the mighty river flows through different channels it creates, it brings with

it, seasons of aggression and peace putting human life and livelihood at great risks. Every year, millions of people are displaced in annual floods in Assam.

Parvati Bhuyan (19) from village Mohmaora says that she has benefitted immensely from boat clinic. She and her entire family have been visiting the clinic.

During heavy rains and floods it was a risk crossing the rivers, walking through dense forests to reach the health centres.

Pregnant women, senior citizens, children have benefitted immensely

Many are affected by waterborne diseases. A major problem is access to medicines and sustained healthcare. Most islands totally lack basic infrastructure and services; from health to schools, from power and roads to drinking water and sanitation.

The nature of the river is such that making Assam floodproof is beyond the bounds of

possibility. Hence, what remains in the hands of a man is to develop the ability to cope with the aftermath of the floods.

Boat clinics initiated by the Centre for North East Studies and Policy Research (C-NES) in partnership with the National Health Mission, Government of Assam, is one programme that

PATIENT TESTIMONIAL Namita Yadav (32) of Dibrugarh district of Upper Assam, says that they have been visiting the boat clinic since 2008.

Free treatment, medicines, and injections are provided at the clinics. It is not possible for them to visit private doctors as the visits are expensive. Intially they were unaware about pregnant women being administered TT injections. Now, these services are available every month serves these marginalised river island dwellers with sustained basic healthcare facilities since 2005. The concept was envisaged to address and bridge the gap in access by converting challenges into opportunities.

“In 2004, C-NES won the World Bank’s India Marketplace 2004 competition for this unique innovative concept of a ‘Ship of Hope in a valley of Floods’ that could transform the lives of rural communities. With the award money of $ 20,000, a boat christened ‘AKHA’ meaning hope in Assamese was designed

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and built involving indigenous local expertise from Dholla and Sadiya in Upper Assam and under the supervision of a boat builder from Dibrugarh. The wooden boat, 65 feet in length and 15 feet in width with space for an OPD, laboratory, cabins for doctors and nurses, kitchen, toilets, water supply, a generator

set and powered by a 120 Bhp Tata engine was completed within eight months’ time. The journey of the boat clinic began since then,” recalls Ashok Rao, Program Manager, C-NES, Guwahati.

What started off as a small initiative to provide healthcare access has now become a lifeline

for thousands of people living in this terrain. He informs that today they have 15 boats functioning under this programme with support from individual donors like economist Swaminathan Aiyer who has donated five of the boats, Supreme Court Swaach Bharat Expert Almitra Patel who has donated solar

lights to each targeted islands villages and corporations such as, Oil and Natural Gas Corporation, Oil India, Indian Oil Corporation (Assam Oil Division), Numaligarh Refinery Limited (NRL), State Bank of India, SELCO Foundation and Mahindra Mahindra Financial Service, Godrej Appliances, etc. The boat

STRATEGY clinics operates in 13 districts along the Brahmaputra river, treating about 20,000 people a month for free. Moreover, the boat clinic at Malkangiri, Odisha, launched in May 2017 was inspired by the success of C-NES’ Boat story to provide service to tribal populations in (Maoist) disturbed areas. C-NES was invited to provide technical guidance and planning for the programme.

How these clinics function?

A series of camps to deliver services are organised by developing work plans for each district to cover the islands in association with the NHM, the Joint Directors of Health as well as CNES’ teams of District Program Officers (DPOs) and Community Workers; the former are the organising core of the outreach.

The teams make five to six trips per month to selected islands and conduct camps for 18 to 20 days taking into consideration of the routine immunisation schedule rounds. With the involvement of local communities, the DPOs hold camps in a series of villages.

“Camps are announced through ASHAs and village headman and local residents by the DPOs and CWs to ensure extensive participation. In upper Assam districts of Dibrugarh and Dhemaji, the targeted island population also receives prior information through the Brahmaputra Community Radio Station established by C-NES with support from UNICEF,” explains Rao. The focus areas include the following: general checkups, minor surgical procedures and suturing, antenatal checkup and related services (critical for Assam with the highest maternal mortality rate in the country and an equally high infant mortality rate) e.g. injection – tetanus toxoid, iron and folic acid tablets, referral for complicated pregnancies, promotion of institutional deliveries postnatal checkup, immunisation, treatment of common childhood illness, basic laboratory services, referral of complicated cases and awareness building on the importance of family planning, general health as well as of personal hygiene, proper nutrition and

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GODREJ APPLIANCE’S EFFORTS medical supplies are required to be stored precisely between 2 – 8 º celsius for them to be effective.Surge or drop in temperatures would render the costly vaccines unusable.

JAISHANKAR NATARAJAN Product Group Head Godrej Medical Refrigerators

When did Godrej get associated with the boat clinic?

In 2017,the Jorhat boat clinic was installed with a Godrej Medical Refrigerator with Support from SELCO Foundation,to provide a reliable solution for storage of vaccines / medicines required for an extended journey.

The results were encouraging enabling longer journeys and greater coverage per trip.In one ideal trip,the boat would leave the banks of Jorhat and travel for a minimum of seven days,setting up medical camps on various islands before returning.

Post this success,in 2018,another boat,the Tinsukia boat clinic was equipped with Godrej Medical refrigerator.

The vaccines and other temperature sensitive

What is Godrej’s contribution to this project?

The Godrej medical refrigerators are powered by the Sure Chill technology,a unique cooling technology that ensures perfect temperature control with no risk of freezing.This innovative technology stores the vaccines in a combination of ice and water based on the anomalous behaviour of water at 4ºc,allowing perfectly stable cooling throughout the entire fridge.

Till date,out of the 15 ‘boat clinics’which currently operate,two are equipped with the reliable Godrej medical refrigerators.On an average,16000 people are provided with basic healthcare through various medical camps,awareness camps and immunisation camps every month,with the help of these unique boat clinics equipped with Godrej medical refrigerators.We are in talks to equip the remaining boats so that the positive outcomes observed in these two boats equipped with Godrej medical refrigerators,are scaled up.

A child undergoes check up

sanitation as well as screening of health documentaries to develop awareness on the issues. There are two MOs or Medical Officers and paramedical staff includes two ANMs, a GNM, a pharmacist and one laboratory technician in each of the 15 boat clinic units and supported by three community worker and four boat crew. One district programme officer is the team leader who coordinates and liaisons with the community and district officials and is the core of the programme in each boat clinic unit. The district boat clinic units are supported by the programme

management unit (PMU) team stationed at Guwahati.

Speaking about the support received by the state, Rao informs, “NHM supports the total cost of the programme. UNICEF supports the community radio station and a unique education initiative which brought learning skills to out-of-school children on the saporis of Dibrugarh and Lakhimpur. The school programme has since been taken up by the Sarba Shiksha Abhiyan, Dibrugarh. Training and capacity building support for the radio station is being provided by UNICEF.”

Improved health outcomes This programme focusses on improving health indicators by introducing certain core functions: Improve ANCs: “Assam has the poorest MMR figure in the country as was mentioned earlier.

Maternal deaths were more frequent in islands due to lack of health centres and trained TBAs to conduct safe deliveries.

Most of the deliveries were conducted by the quacks or untrained birth attendants in a primitive way and thus contributed to high maternal deaths,” highlights Rao. Through the efforts of boat clinic services,

now almost all pregnant women regularly comes to the health camps for ANCs and number of institutional delivery cases which is being constantly advocated by the health teams have increased. MMR in Assam showed the most improved decline from 490 during SRS 20032006 period to currently 237 SRS 2014-16.

Increasing child immunisation: According to Rao, people in these areas did not support child immunisation initially and the boat clinic team had to face a lot of challenges to convince the people about providing vaccination to their children. They were successful in convincing the people through intensive awareness sessions and counselling and now more than 80 per cent are being fully immunised.

PNC services: Assam also has bad IMR figure in the country (44/1000 live births SRS 2016) and this is mainly due to lack of PNC services. According to CNES, the boat clinic services has been able to improve PNC services and ASHA workers are encouraged to ensure follow up visits among the targeted population.

Family planning: People have now started to think about the concept of planned family in these riverine areas and are convinced about the benefits of small family. In the early stages of the boat clinic intervention, CNES in partnership with Population Foundation of India (PFI) had worked on a project on family planning. In the first phase of the project implementation in 2009 there was strong resistance especially from religious minority dominated communities and most religious leaders.

The project involved capacity building of field level health workers, extensive use of IEC & BCC, FGD, counselling, engagement of experienced medical professionals working in the field who could interact in the local dialect. Gradual changes took place and were visible in the 2nd phase of the project (2013-16) where misconceptions and taboos could be cleared and removed. Today people in these areas come voluntarily asking for family planning services.

Number of surgeries: Till March 2018, the boat clinics

STRATEGY have been successful to achieve 1098 laparoscopy surgery, 1012 IUCD insertion and 18 NSV. Health awareness: Apart from this, the boat clinic health camps also hold regular awareness sessions on health and related social issues making the people aware about the importance of looking after their health. Other services such as special immunisation i.e.

JE are also regularly given in these remote areas.

Challenges Efforts taken by the boat clinics’ team are commendable; however, their journey is daunting.

The greatest challenge for health workers in this terrain is the changing climatic conditions and natural calamities like storm, dust wind, very strong current and floods during monsoons.

Rao lists down some road blocks: ◗ Bureaucratic shortcomings There are many limitations and difficulties while implementing this innovative healthcare services as this programme is implemented in association with the NHM, Assam and is totally dependent on timely fund release and medicine supply by the mission. ◗ Technical difficulties: Since boat is the only means to carry out the programme in these targeted locations, sometimes camps are affected due to technical difficulties of boat and also duration of boat maintenance repairs for smooth implementation of the project. The other challenge is frequent exit of young doctors who normally serve in the boat clinics to complete their one year compulsory rural posting to qualify for PG entrance in the state as boat clinics service is recognised by the state government as qualifying criteria. ◗ Difficult terrain: Low water level during winters is another challenge as the boat clinics have to be docked far away from the camp site or community and the team have to walk for miles to reach the camp sites carrying medicines, vaccines and other materials. On many occasion additional mode of transport like horse carts, tractors, canoes, small boats, motor bikes and cycles have to be used. Most roads leading to the ghats, (where the boat is docked) is

SELCO’S VISION FOR THE BOAT CLINICS HUDA JAFFER Lead Designer, SELCO Foundation

How is the SELCO Foundation associated with the boat clinic?

SELCO Foundation partnered with Centre for North Eastern Studies to understand how energy access would help deliver better services on the boat clinics run by CNES along the Brahmaputra.It examined aspects such as what does it mean to have unlimited energy available on a boat for healthcare delivery? How do we redefine energy infrastructure for health for island communities by partnering with C-NES and how can such a model be institutionalised for other similar geographies or island nations of south east Asia?

What is your contribution to this project- investment done, etc?

SELCO Foundation wanted to understand the modalities of energy access interventions,and the processes involved when designing the mobility in healthcare, specifically in a river travel context.We looked at two main aspects here- 1) Efficiency of energy consumption on the boat for various functions and designing for energy systems and technology that can allow for decentralisation and portability; 2) Analysing the cost on energy from an operations perspective on what savings does it lead to? Does it add value in terms of the quality or quantity of services; or even general well being of the service providers? What does that mean for a health program from the state or government perspective?

These were some of the questions we were trying to answer and innovate upon through the pilots done in partnership with C-NES. What are the lessons learnt from this project?

SELCO Foundation early on realised that the largest

impact arising out of the intervention would be the staff of the boat itself,who would in-turn be able to extend this benefit to the communities being served too.Access to energy (in a manner that wouldn’t run out — as in the case of kerosene which needed to be monitored and carried along with every 10-15 day trip by the staff on the boat- but would be generated and stored everyday) meant that the doctors and nurses were able to deliver services in a comfortable manner with equipment and appliances that helped increase their productivity.

During the night,having a light on,lab equipment still available for use,laptops to send emails,or even to tend to some emergency cases,were specially a huge benefit.

The partnership with C-NES,as we've said before, looked at re-defining healthcare delivery.It really helped us prove another dimension to decentralised energy generation,the democratisation of services that can result through the process.Energy becomes mobile, which in turn means appliances become mobile and services get delivered at your doorstep.Often we talk about healthcare being free,but the cost to reach the health centre is never accounted for.Decentralised energy and the model of C-NES,deletes this last mile transaction cost completely,which is often the biggest gap.

These models will be also useful for reaching out to flooded communities during disasters.

We also realised that the high recurring expenditure that was incurred by C-NES on diesel and other fuels could be easily re-allocated to a loan or invested in the beginning in the capital cost of solar.The amount that is spent by C-NES on fuel for the health appliances and other technologies would be recovered within four years, resulting in savings from their own,and a much more economical model thereof.

In our analysis on how to optimise for all energy needs of the boat clinic,it was also important to understand the criticality of the different energy needs and the most economic way of delivering it.The boat currently uses a mix of energy sources.It was critical to shift the equipment and appliances on solar (with panels installed on the boat),but the boat itself continues to run on diesel.

Solar power installation at Jorhat boat clinic

between 5 to 50 kilometres distant and is kuccha or pucca but broken and with large pot holes in most stretches. Constant change in the river course and

erosion of land mass which forces families to shift to safer or different locations also make it difficult to serve and meet targets set.

Overcoming obstacles All parties involved in this programme are constantly reinventing strategies and are coming up with solutions that

can combats challenges. “A onesize-fits-all does not and cannot work here – even a distance of few kilometres turns up new challenges, calling for fresh innovations. Learning through experience and adaptation are mostly followed to overcome different situations by each boat clinic units while still maintaining the standard operating protocole,” opines Rao.

Keeping it going The vision for the future is clear.

They envision to add elements such as: bringing solar energy to the poorest households, education through mobile technology, uplifting the people living in these regions, coming out of generations of social and geographical isolation and more. Currently, in addition to human healthcare, veterinarians are also transported to the islands where large cattle populations live, because these habitations are one of the primary centres of milk production in Assam, but, like their owners, the livestock too have no access to healthcare. This is being expanded. Most importantly, the boat clinic programme aims to provide additional education to these isolated population through continuous awareness programmes for better health and good living conditions.

The goal for the future is to see that the isolated island communities are no longer isolated in terms of receiving regular quality healthcare services at their door step through up gradation and improvement in digitalisation, including additional services like dental service (presently two dental set up on boat clinics at Jorhat and Bongaigaon) eye, regular visits by ENT, O&G, paediatrics specialist, linking and networking a robust system of referral transport system for all emergency and referred cases. All VHSN committees are actively involved in the holistic health issues of the community. Going forward, CNES, the Assam state government and all other stakeholders in this initiative will need to keep up with this momentum and conviction to improve, scale and replicate this model in areas that need these kind of services. raelene.kambli@expressindia.com

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‘NHS investment in IUIH will drive step change in healthcare standards’ India has been a priority for Healthcare UK ever since its establishment in 2013 and opportunities in India for British healthcare are expanding all the time. In fact, both the countries have put in place a bilateral agreement to underpin collaboration in healthcare

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he United Kingdom National Health Service (NHS) has again been ranked as the best health system by an influential think tank. An analysis of healthcare in 11 countries, concluded that the NHS outperformed the health systems of; Australia, Netherlands, New Zealand, Norway, Sweden, Switzerland, Germany, Canada, France and the US. The accolade is commendable but even more so when you consider that UK’s spending on healthcare as a percentage of GDP

is substantially below that of large economies such as the US, Germany and France.

Using data from the World Health Organization (WHO), the Organization for Economic Cooperation and Development (OECD) and questionnaires completed by doctors and patients, researchers at the Commonwealth Fund ranked each nation’s healthcare provision through five different quality measures. The NHS was praised for the safety of its care, the systems in place to prevent ill-health, such as vaccinations and

screening, (referred to as Public Health), the speed at which people get help (efficiency) and that there was equitable access regardless of income (affordability). The UK Health Secretary Jeremy Hunt said, "These outstanding results are a testament to the dedication of NHS staff, who, despite pressure on the front line, are delivering safer, more compassionate care than ever.”

Deaths from strokes and heart disease have fallen steeply, linked to greater use of preventive medication including statins and drugs to reduce blood pressure,

Indo UK Institute of Health (IUIH) is already in the process of building eleven 1,000-bed hospitals in India providing employment to more than 3 lakh Indians.Construction of the first IUIH Medicity,a fully integrated facility, is underway already in Nagpur,Maharashtra

DR AJAY RAJAN GUPTA MD and Group CEO, Indo UK Institute of Health (IUIH)

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JEREMY HUNT Health Secretary, England

SIR MALCOLM GRANT

DR GAUTAM MARWAH

Chairman, NHS England

Director, Indo UK Clinics, IUIH

These outstanding results are a testament to the dedication of NHS staff, who despite pressure on the front line are delivering safer, more compassionate care than ever

This is the gap that the NHS with its seven-decade history and innovation technology hopes to help India bridge.

For a country like India,technology like tele-medicine can act as the primary healthcare stop rather than queuing up at a facility kilometres away

Some of the healthcare problems are at a much earlier stage in the life-course of individuals and the NHS has been founded on primary care.

There is a system of triage, where specialists are referred to by general physicians who treat most of the illnesses in society. In the age of technology, high penetration of smartphones can be leveraged well

According to Sir Malcolm Grant, “This is the gap that the NHS with its seven-decade history and innovation technology hopes to help India bridge.”

India’s healthcare market is estimated to grow to $280 billion (around £198 billion) by 2020, according to a report by the Confederation of Indian Industry (CII) and KPMG. According to McKinsey, India will have a total bed density of 1.84 per cent per 1,000 people against the WHO guideline of 3.5 by 2022. Commenting on this immense opportunity, Dr Ajay Rajan Gupta, MD and Group CEO, IUIH, said, “Indo UK Institute of Health (IUIH) is already in the process of building eleven 1,000-bed hospitals in India providing employment to more than 3 lakh Indians. Con-

struction of the first IUIH Medicity, a fully integrated facility, is underway already in Nagpur, Maharashtra.”

Emphasising on the need for primary care, Dr Gautam Marwah, Director, Indo UK Clinics at IUIH said, “Some of the healthcare problems are at a much earlier stage in the life-cycle of individuals and the NHS has been founded on high quality, primary care. There is a system of triage, where specialists are referred to by general physicians who treat most of the illnesses in the community. In an age of technology, high penetration of smartphones can be leveraged well. We are exploring the ways and means that disruptive technologies can be used for treating the patients.”

and smoking cessation campaigns. Additionally, the NHS has embraced a wide range of treatments and public health social marketing initiatives.

In June 2016, Sir Malcolm Grant, Chairman, NHS England; Deborah Kobewka, Managing Director, Healthcare UK and 23 British organisations had come to India on a visit under the theme of 'Smart Healthcare.'

Linked to the smart cities initiative, the Indo UK Institute of Health (IUIH) project, now has King’s College Hospital as the strategic partner for two of the planned 11 institutes.

Around one million Indians die every year due to inadequate healthcare facilities and about 700 million Indians have no access to specialist care.

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he government’s big-ticket reform - Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (PMJAY), is all set to take flight.The first phase of the world’s largest health insurance plan will be rolled out in 14 states and two union territories on September 25.The programme intends to change the healthcare landscape of the country by providing a insurance cover to 10 crore households, i.e. 50 crore individual beneficiaries with ` 5 lakh per family per year.The ministry officials handling the scheme tout it to be a revolutionary scheme and a boon for the Economically Weaker Sections (EWS) who are usually pushed into a debt trap due to healthcare costs.

After unfurling the Indian flag on 72nd Independence Day at the ramparts of the Red Fort, Prime Minister Narendra Modi, announcing the official launch of AB-PMJAY said,“On 25th of September, the birth anniversary of Pandit Deen Dayal Upadhyaya, the Pradhanmantri Jan Arogya Yojana (PMJAY), will be launched throughout the country. No poor person of the country will have to face difficulty in dealing with diseases. Nor he would have to borrow money from a moneylender paying interest.The scheme will open new avenues of employment for the youth as well as for the middle class families in the health sector. New hospitals will be built in the tier-II and tier-III cities and a lot of employment opportunities will be generated.”

Informing that beneficiaries were almost equal to the combined population of the US, Mexico and Canada or of the European Union, he said,“The common man gets free treatment for serious diseases and he can be admitted to big hospitals free of cost. In the coming days, people from lower middle class, middle class and upper middle class income groups can also access healthcare services from these two programmes.This is a technology-driven system which is transparent.As such, an ordinary citizen will not face any difficulty as technological tools have been built for this purpose.”

The services include more than 1300 procedures that covers pre-and post-hospitalisation, diagnostics, medicines etc.

Beneficiaries are able to move across borders and access services across the country through the provider network seamlessly.Though the scheme looks optimistic, healthcare experts indicate that nationally mandating a health insurance system needs to improve the quality of government infrastructure pan India and offer better opportunities for the private sector at a right price.The central government is trying to align with state governments and woo private players.The PMJAY is trying to create a major shift in reshaping the horizon of public healthcare space, but the proof of its success lies in its implementation.

In this issue, stakeholders of the healthcare industry viz insurance companies, policy makers, med tech players share their views and opinions about ‘AB – PMJAY.’

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cover ) AB is a welcome step in the direction of achieving Universal Healthcare A

B-NHPM (recently, rechristened as Ayushman Bharat: Pradhan Mantri Jan Aarogya Yojana) would be the largest government sponsored health assurance scheme that the world has ever seen, covering more than 50 crore individuals from economically weaker sections (EWS) of the society, identified through SocioEconomic Caste census (SECC).

It also aims to improve the quality of primary healthcare infrastructure through creation of 15,000 health and wellness centres across the country.

Administration of the scheme through a common IT platform promises a rich database on panIndia network of hospitals, nature and category of illnesses, preferred choice of treatment destination

Systemic challenges AB: A bridge to achieve UHC Universal health coverage involves access to quality health services – from prevention, treatment, rehabilitation and palliative care to all, without causing any financial hardship in the process. That is to say, access to quality healthcare services should not come as a financial shock that may push the family into debt-trap because of catastrophic out of pocket expenditure. AB aims to provide quality secondary and tertiary healthcare to about 40 per cent of India’s population through private as well as public empanelled healthcare providers to the extent of `5 lakhs per family per annum. Another key objective of this scheme is to induce health-seeking behaviour in EWS who did not have access to services of private healthcare providers till now because of prohibitive costs.

AB is a welcome step in the direction of achieving UHC which also forms a part of safety needs in the Maslow’s need hierarchy.

Ensuing a paradigmatic shift With implementation of government-sponsored secondary and tertiary healthcare at such unprecedented scale, discourse

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Ashish Modi, Joint CEO, Rajasthan State Health Assurance Agency

on public health management in India will see a paradigmatic shift from supply-side interventions to demand-side interventions. A balanced combination of the two is extremely important to ensure availability of quality services as well as its accessibility to the poor and needy. Such a paradigmatic shift also poses immense opportunity for the medical insurance industry to penetrate deeper into the citizenry, much beyond only 10 crore lives insured through retail and group insurance till now.

Unstated goals AB, apart from its stated goals, has many other inherent promising advantages in its design.

Through standardised treatment guidelines and standard package rates, the differential cost of treatment at high-end private hospitals shall vanish.

Administration of the scheme through a common IT platform promises a rich database on pan-India network of hospitals, nature and category of illnesses,

preferred choice of treatment destination, etc. Such rich empirical data can be analysed to make well-founded policy interventions in future.

Implementation AB, like many other in-patient healthcare systems across the world, shall be operationalised through an ecosystem comprising of beneficiaries, empanelled healthcare providers (EHCPs), insurance company (or Trust), TPA, IT service providers and the government as overall stage-setter and cost-bearer in the government-sponsored system. All the stakeholders in the system have their share of benefits. In the process, the beneficiaries receive quality healthcare (for IPD treatment) at no direct cost, EHCPs get business through increased foot-fall of patients, insurance company/TPA get business through insurance premium/ service cost paid by the government and lastly, the government achieves its objective of social good.

For the ecosystem to operate in a stable equilibrium and achieve its goals successfully, the interests of all the stakeholders must be properly accommodated without creating concerns for another. Firstly, a realistic pricing of insurance premium is sinequa-non for the ecosystem to deliver through Insurance company/TPA. Secondly, package rates should be remunerative for the private EHCPs to board the ship. Unless private hospitals are taken on board, main objective of providing quality healthcare to EWS would suffer. AB has provisioning for quality of service and difficult area of operation, which shall compensate for the extra costs of operation.

Thirdly, a herculean challenge is to design robust fraud mitigation and grievance redressal system brings in efficiency and satisfaction in the system for all stakeholders. Lastly, a welldesigned IT platform for operation from beneficiary identification to claim processing is mandatory to ensure identification of ghost beneficiaries, timely pre-authorisation as well as hassle free claim settlement.

Operational challenges A major challenge would be to bring the beneficiaries to EHCPs. A letter is being sent to

all beneficiaries regarding their entitlement, but this may not be enough. The extensive network of ASHAs, ANMs and AWs should be used for the scheme to fly high. Further, there shall be many other operational challenges that AB may face at the field level. Some of them can be – fraudulent admissions, unnecessary hospitalisation, unnecessary/avoidable surgeries, charging money from patients even though the scheme is cashless, blocking of higher/multiple packages, connivance between beneficiaries and hospitals etc. However, the solution lies in making use of systemic support of robust IT platform, coupled with field level audit and detailed analytics at hospital/ doctor/ package levels, to identify such fraudulent practices and nip them in the bud.

Way ahead It is imperative that systemic and operational challenges are addressed, detailed protocols and guidelines are put in place and public discourse on AB is initiated in mission mode. The well-intended and much-needed scheme can, only then, bring in quality, transparency, standardisation and cost-efficiency in public healthcare management in India.

(Views expressed are entirely personal)

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Insurance as a healthcare financing mechanism will always have a major role to play A

yushman Bharat rechristened as the Pradhan Mantri Jan Aarogya Yojana (PMJAY) is the largest health insurance scheme, which has been very well conceived with a lot of ground work done by the government think tank.

PMJAY would be implemented by majority of the states in three different models trust, mixed and insurance model. While we presume the reasons for the governments in deciding to go for a trust model are on careful analysis of their earlier experiences, this decision has surprised the insurers because of the sudden change of approach by many states as insurers have played a very important role in implementing government schemes till date.

Non-life insurance companies and health insurance companies are highly regulated by the Sectoral Regulator in terms of ◗ Protection of policy holders interest ◗ Investment of policy holders’ funds ◗ Control on expenses of management and solvency.

Insurance companies have got significant experience in handling mass insurance schemes of central and state governments. These trusts formed should develop expertise in implementing such large schemes, build efficiencies in doing so and may also involve substantial costs in developing capacity. To avoid the ills of being monopolistic in implementation without the element of competition such trusts will have to ensure they do not face implementation issues and have a strong grievance han-

Each state government need to set up separate trusts and these trusts would manage schemes like any other government schemes

Shreeraj Deshpande, Future Generali, SVP and Head Operations, Customer Service and Health Insurance

dling mechanism. Competing insurance companies brought in higher levels of service and optimisation of price and implementation costs.

Each state government needs to set up separate trusts and these trusts would manage schemes like any other government schemes. The efficiency of respective trusts and practices adopted will differ from state to state and efforts are needed to bring in uniformity.

Very few states have been able

to regulate the healthcare sector in their respective states and this could be an opportunity to implement or adopt the Clinical Establishments Act across all states.

One of the most basic objective of insurance is spread of risk. Implementing insurers spread the risks over the entire geography of the country while respective trusts concentrate the risks within the same state.

The implementing agencies from different states will have

to pool and learn from different experiences across the country in implementing such schemes effectively. A strong mechanism should be in place.

The success of this scheme would be mainly dependent on implementation of the scheme.

Regulating providers, controlling frauds and most importantly the will to effectively implement such schemes would be of paramount importance.

If we go by the life cycle of such schemes one can observe that they start with lower awareness, lesser utilisations and lesser outflows. Over the years as awareness increases, the utilisations increase and after a period of 4-5 years the utilisations reach high levels.

Maintaining the efficiencies in implementation at this stage would become very important considering both the utilisation costs as well as costs of implementation.

Healthcare costs would be increasing because of increased utilisations and medical inflation. Today the Central and State Governments spend 60/40, 90/10 or 100 per cent depending upon the states/UT involved. Will both the central and state be able to continue spending in the same manner without a strain on the budgets of the governments, hopefully yes, with a stronger economy.

What would be the alternatives

available at that time to mitigate such risks? Will transition to voluntary insurance models partly, or part financing by the citizens would be one of the few options thought of?

Alternatively, will this ultimately cover the entire population of the country, which is less likely given the numbers in our country.

Out of pocket expenses still amount to 62 to 65 per cent of healthcare expenditure. The challenge is to capture a significant part of current household spending and assure that the total was spent on more cost effective and higher quality services. Therefore, insurance as a healthcare financing mechanism will always have a major role to play. Smooth migration of population from fully government funded schemes to voluntary insurance model as the economy flourishes will be very important.

Lastly an integrated approach of the 1,50,000 wellness centres catering to the out-patient requirements and acting as gate keepers for hospitalisation, developing capacity by means of upgrading district hospitals and medical college hospitals to tertiary care speciality hospitals will play a major role in successful implementation of this scheme on the long run.

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cover ) AB: A demonstration of will to make universal healthcare work in India T

he healthcare and health insurance sector in India received a much-needed shot in the arm during this year’s Union Budget. The government’s plan of covering hospitalisation expenses for around 500 million poor citizens under the Ayushman Bharat National Health Protection Scheme is a significant step towards universal healthcare. Its sheer magnitude is huge. Since the government has also announced to launch the scheme on September 25, work is being expedited in the country to ensure it becomes a reality. This needs to be carefully managed, and more importantly, the selection of right health insurance providers is a critical function to the overall success of the programme.

Given the healthcare sector is one of the largest job providers in India, the scheme will offer opportunity for development and empowering the weaker sections of the society in more ways than one. When implemented, it will not only build new healthcare facilities in every districts and villages but will also potentially create lakhs of new jobs. It will be a game changer in empowering India’s poor and underprivileged. It has the potential to become the cornerstone of India’s healthcare needs.

Also, the need of healthcare infrastructure for the new scheme will be of a huge scale.

To raise a new army of medical professionals and hospitals, imagine the number of medical colleges, paramedical schools

Antony Jacob CEO, Apollo Munich

that would have to be built and the jobs that it would in turn generate. That is just at the back end. When it comes to the front end or the actual healthcare delivery, it is estimated that every additional hospital bed

creates five direct and 25 indirect employment opportunities.

Thus, under this programme millions of new jobs can be created.

A further critical catalyst in establishing foundation for future collaborations and enhancing partnership from private sector is the PPP model.

Nowhere in the world does a model exist where the public sector finances the entire country’s healthcare expenses. While the primary responsibility lies with the government, private players offer the benefits of innovation and efficiency. For instance, the private sector accounts for nearly 40 per cent of the overall available hospital beds but caters to 80 per cent of patients in both urban and rural

areas. This simple statistics highlights the pressing need for PPP models to increase access and enhance the utilisation of unused government healthcare capacity. In this context, ABNHPS is uniquely positioned to expand the scope, making it a true universal, end-to-end healthcare scheme.

Overall, the implementation of NHPS is a major undertaking, something that is unprecedented in India, and taking place over a large scale. In my view, the initial years will provide valuable learnings and insights that will help scale up the scheme.

Having said that, the scheme definitely has much potential tobring India another step closer to being a truly health confident nation.

It has the potential to spur major growth in the insurance sector T

he implementation of Ayushman Bharat — Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) , the NDA's flagship entitlementbased scheme, is set to cover 100 million households, i.e. 500 million individual beneficiaries with ` 5 lakh per family per annum. An insurance plan which is now being showcased as a boon for the many who are in danger of being pushed into a debt trap due to prohibitive healthcare costs. As per the Insurance Regulatory and Development Authority of India (IRDAI), out-of-pocket medical expenses make up about 62 per cent of all the healthcare costs, with 35 million to 65 million people are pushed into poverty based on different thresholds

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due to high out-of-pocket expenditure on health, which is extremely regressive.

The roll-out of AB-NHPM (at least in a few states) was expected to be on August 15.

Due to minor setbacks, the central government has chosen to roll out the plan in September.

Out of the 36 states, 29 states have come on board with the scheme. The scheme looks at over-ambitiously insuring a large number of people based on their socio-economic and caste.

Under the scheme, both private and state-run insurance companies are said to have been given contracts after a state-wise bidding process.

Insurance premia are to be fixed according to the number

Dr Usha Manjunath, Director, Institute of Health Management and Research Bangalore

of eligible beneficiaries in each state. AB has the potential to spur major growth in the insurance sector. The current infrastructure in place is a definite challenge as the scheme’s success hinges on making the primary health infrastructure more robust and ensure the participation of private hospitals as they cater to 80 per cent of the healthcare needs.

The scheme is being rushed through during its roll out, a scheme like this needs to be well thought out and every minute detail must be taken into consideration. The intent with which it is being rolled out is great, but it doesn’t take into consideration emergency cases.

Another key factor in this scheme is the role of private

hospitals and their willingness to participate. The infrastructure and quality provided by state-run hospitals will not be able to sustain such a large number of patients alone. Infrastructure too lacks the ability to provide the same quality that private hospitals provide.

AB needs to place their financial model in consideration with future hikes in prices in the industry and upgrading state-run facilities, for the project to become successful. The scheme also needs to change the basis on which population is included under this scheme. AB has a great potential in leading India to lower the healthcare cost overall, improve health status and achieve universal coverage in the next 8 to 10-year timeline.

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Healthcare providers need to build efficiencies rather than look at pricing O

n the eve of August 15th, 28 states and UTs had already signed the MoU for Ayushman Bharat National Health Protection Mission (AB-NHPM). The National Health Protection Scheme (NHPS) has been credited as the world’s largest health insurance plan. It aims to provide a health insurance cover of up to ` 5 lakh annually to 10 crore families, which would in turn cover 40 per cent of country’s population.

RSBY, the earlier predecessor of Ayushman Bharat was able to reach 3.6 crore families over a 10-year timeframe against a targeted coverage of six crore families, let’s say 60 per cent success rate in 10 years. Undoubtedly, the scheme is very well intentioned and fundamentally ambitious which is the need of the hour. However, there are few crucial pillars to make it successful infrastructure, workforce and a strong focus on overall quality.

Infrastructure creation and utilisation India has around 1.6 million hospital beds and around 55,000 hospitals (excluding community health centres and primary health centres). While metros and tier-I towns have as high bed density as four beds per 1000 population, other towns lag far behind.

The government needs to smartly build capacity starting with primary healthcare. Good primary care is essential for a healthy nation and in the same context AB also proposes setting up of 1.5 lakh health and wellness centres across the country. Addressing problems associated with supply logistics and spurious medication is another challenge. There could be an opportunity to tie up with players involved in last mile logistics to tackle some of these challenges.

Ritesh Dogra, Managing Partner, Medium Healthcare Consulting

One of the potential roadblocks could be participation from the private sector. There has been a lot of debate around procedure pricing across multiple platforms, most of it around viability of proposed pricing. Private healthcare providers are reluctant to enrol with NHPS at the current procedure pricing. However, healthcare providers need to build efficiencies rather than look at pricing in isolation. In states such as Rajasthan which has Bhamashah Swasthya Bima Yojana (BSBY), a state-run insurance scheme with prices comparable to Ayushman Bharat, healthcare providers have gradually built in efficiencies to make this successful and in turn also generate surplus. Another counterargument to the pricing paradox is reflected in the number of registered hospital projects in pipeline. Currently, there are ~500 registered hospital projects in pipeline with an overall documented investment of ~` 80,000 crore. In addition, quite a few international play-

ers are eyeing a large share in the Indian healthcare, IHH being one example. Increased state coverage would undoubtedly increase access to healthcare and hence hospitals would witness an increase in patient volumes. On the face of it, pricing does not seem to be a deterrent to the success of the scheme. The overall margin for hospital providers in India has historically been higher than some of their counterparts across the globe and this could partially explain why international providers eyeing the Indian market see the scheme as an opportunity. NHPS would, however, need to streamline the entire billing and collection cycle to enable hospitals manage their cash flows; currently this is a gap across most staterun health insurance schemes.

Bridging the workforce gap Our country has around one million doctors. While states like Karnataka and Tamil Nadu have 1.5 doctors per 1000 population, states like Bihar

and Assam have less than 0.5 doctors per 1000 population.

Apart from physicians, contractual staff accounts for more than half of skilled workforce in the country. Creation of skilled manpower through training courses could increase resource efficiency for doctors. Healthcare Sector Skill Council (HSSC) has already taken the initiative to create a better skilled healthcare workforce. Certain practices such as midwifery which have been quite successful in other countries need planning and mass implementation.

There are sporadic learnings from other countries as well.

Ethiopia has a concept of health extension workers who are rural high school graduates undergoing one-year training before they are sent back to their native areas; the practice has led to reduction in child and maternal mortality by 32 per cent and 38 per cent respectively.

Delivering quality In India, the average length of doctor consultation is little more than two minutes and features a single question – “What’s wrong with you?”

Not surprisingly, research done by World Bank has shown that only 30 per cent of the consultations have resulted in correct diagnosis.

While we have quality standards drafted by bodies such as NABH (National Accreditation Board for Hospitals), compliance is altogether a different subject. We need to create incentives around quality for empanelled hospitals. Undoubtedly this would entail a large-scale quality and patient experience audit beyond the existing conventional practices. Practices such as HCAHPS (Hospital Consumer Assessment of Healthcare Providers and

Systems) in the US need to be studied and could be suitably adapted to the Indian context.

Monitoring dashboards Internationally, eight to ten percent of resources are wasted due to fraud and scheme abuse. Experts opine that Obamacare takes 40 per cent of resources for monitoring. It is important to create right monitoring dashboards for the success of the scheme starting from identification and verification of beneficiaries to hospital empanelment, diagnosis and treatment and claims vs complaint. At each stage, a robust monitoring would ensure large scale and long-term success of the scheme.

Spending in healthcare was earlier dubbed as social overhead but now economists at World Bank have documented evidences that this spending accelerates the growth of the nation. If implemented well, there are clear evidences of the impact NHPS would create in meeting the healthcare goals of the nation; some of them being increase in average life expectancy by five years, reduction of child deaths by ~ 50 million and many more. A participative and inclusive approach by government and non-government healthcare providers would be critical to success of the largest healthcare insurance plan across the world.

As Dr Indu Bhushan, CEO, AB puts it, “Constraint is not money but the capacity to spend the money effectively. We need to strengthen existing capacity. We need to put people in place, strengthen capacity of their hospitals, empanel more hospitals, select and train Ayushman Mitra, ensure monitoring systems to know how the money is being used”.

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cover ) A bold step towards healthy future F

irst and foremost the announcement of AB is a bold statement by this government and the size of the scheme itself is intimidating.

Highlighting a few things good about the AB - Pradhan Mantri Jan Aarogya Yojana, the largest government sponsored health assurance scheme, brings in a huge size of money from the government for the healthcare industry. It would be largely consumed by second half of the pyramid. If not all, majority of costs are HR costs and this will open up a lot of job opportunities to paramedical staff.

So far the beds of hospitals that served, heavily occupied by the rich would be equally distributed to even those less

occupied hospitals in small towns. Huge volumes of work in the diagnostic and therapeutic - will get accumulated and those volumes will improve efficiencies and optimise costs.

Usually the worry for the hospitals was on — From where will I get business! but now the worry will be how will make profits out of this volumes. After the roll-out of AB, the consumer need not pay, he will invest time so that the diseases and disorders can be identified earlier, which can improve the quality of life.

Overall countrymen could be healthier if it is implemented without hassles of delivery.

Few of the challenges which can be foreseen are the costings in hospitals — For proce-

Dr A Velumani, Founder, CEO and MD, Thyrocare

dures, these are going to be challenged and new rate lists

will be put forth that would be volume corrected. For example every hospital will have to learn from Arvind Eye Hospital on how volumes decide the quality and not cost alone. According to me, as of now, the costs declared by government needs tweaking for some sensitive and cumbersome procedures.

Another important concern is, we do not have enough beds nor doctors to cater to 50 crore target people who are said to be covered under AB, if they start consuming the insurance seriously. Common man will also have too high expectations in terms of standards that can put cost constrained hospitals into stress.

With all said, claimed and

argued, this ambitious AB project will have a huge impact on government budgets, infrastructure limitations, implementation controls, fraud control mechanisms and above all the health of the countrymen in long run. More hospital visits will result in more tests, consumption of more medicines and performing more clinical procedures will result in a society with improved quality of living.

Many historical journeys begin with some idea about how the path would be. But path is known only when one is on a journey and all what it needs is courage not to give up and stamina to keep walking.

Acche Din Aanewala hai - for Healthcare.

Together, Let’s Make India Healthy A

yushman Bharat-National Health Protection Mission (AB-NHPM) also fondly known as ‘ModiCare’ is an ambitious scheme of Government of India to provide a cashless cover of `5 lakhs per family per year for hospital care to about 108 million families.

These families are identified based on a criteria using socioeconomic status. The main objective behind the scheme has been to provide healthcare to these poor family members without any out of pocket expenditure. To provide affordable healthcare has been a challenge however it is not the only challenge as access to healthcare facility and then the quality and safe care are even greater challenges. Under the scheme, National Health Agency (NHA), the implementing arm under Ministry of Health would be empanelling the private and government hospitals and this will be a marathon task. This will require identification of healthcare facilities those are willing to provide care under the scheme

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and also ensuring a particular level of quality benchmarking.

NHA has defined an empanelment criteria but again checking on the compliance with these criteria will be a challenge and would require additional resources. Prescribing accreditation will not help as there will be just few hospitals under that category, however encouraging a system of compliance checking and monitoring of the empanelment criteria may be an option to make the empanelment process successful and sustainable. This will provide an objective way of compliance to the prescribed empanelment criteria on a continuous basis by all empanelled healthcare facilities.

To effectively implement the scheme a proper coordination with the state health authorities is a must, as each state has its own style of functioning. A robust IT platform would be essential to minimise possible roadblocks for empanelment of hospitals, registration of beneficiaries, management of patient and treatment records, referral

Dr Bhupendra Kumar Rana, Founding CEO, Quality and Accreditation Institute

records etc. and to standardise the process and execution of the scheme. Pilot testing of an IT system has just started and we need to see how it will fare.

Insurance companies have already started talking about fraud management which means this is another challenge for the scheme to optimally utilise funds and maintain a low premium to be passed on to the

insurance companies.

As the scheme is so huge both in terms of operations and finances that every penny saved would have a remarkable impact on the overall viability and future of the scheme. Therefore, looking for options to reduce burden on the hospitals would certainly help in sustainability. Home Health Care (HHC) is a concept wherein many of the needs of a patients can be taken care at the comfort of their homes and, therefore burden from hospitals is reduced to provide hospital care to more needy patients. As per the industry estimate, the cost of home healthcare is about 25 to 50 per cent cheaper than a hospital stay depending on the services taken.

It also saves from the extra expenditures associated with a hospital stay. Which means, shifting from a hospital to home care would reduce the burden of NHA significantly and also hospital beds would be available to more needy patients. However, in the absence of a regulatory or quality framework, HHC has not yet become an organised sector. To

keep in mind the need, Quality & Accreditation Institute (QAI) has been working for last one year to develop accreditation standards for home healthcare using a technical committee of experts from this field. Accreditation standards are now available for use and provides a framework of quality and safety in HHC. Industry has welcomed these standards and adopting to standardise their processes for better outcomes. As per the feedback from the HHC providers and insurance companies, this accreditation program is expected to support AB in a big way.

The scheme will be successful in many ways and it is a step towards Universal Health Coverage and Sustainable Development Goal-3 (Ensures healthy lives and promote wellbeing for all at all ages). AB-NHPM will change the face of Indian healthcare industry in a big way by throwing greater challenges and bringing more opportunities, both for providers and receivers of healthcare. We have a long way to go.

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VIEWPOINT

India’s tectonic shift towards UHC T

he world’s largest health insurance scheme finally saw the light of day with the Prime Minister’s announcement on August 15, 2018. The scheme promises a health cover of `500,000 per family (for around 10 crore households). In addition, the scheme envisages setting up of more than 150,000 health and wellness centres throughout the country to provide primary and preventive care. The scheme marks the transition of the Indian government’s role in healthcare—from a provider to a payer. It also lays the foundation to fix a healthcare system characterised by supply side financing, high fragmentation, non-standardisation and questionable outcome.

Although every developed country offers some sort of government-sponsored health insurance benefits to its citizens, the Pradhan Mantri Jan Arogya Yojana (PMJAY) is different in multiple respects both from a coverage and roll-out perspective. While the amount insured is significant, the scheme itself is

non-contributory (tax funded) with no underwriting activity involved. A standard premium will be given per family, irrespective of pre-existing illnesses or size of the family household. There is no beneficiary identification process and beneficiaries will be enrolled on the basis of Socio Economic Caste Census 2011.

Furthermore, the scheme can be managed both by trust-based model and insurance model.

However, with a majority of states opting for a trust-based model, a scheme of this magnitude may miss the rigour of fraud prevention and medical claim analytics processes built in private commercial insurance business.

Besides improving financial affordability, the scheme also addresses other significant challenges in Indian healthcare. The scheme advocates standardisation, with incorporation of package rates, standard treatment guidelines, common medical data dictionary and standard operating protocols for beneficiary identification and transaction

Dr Rana Mehta, Partner and Leader – Healthcare, PwC

management. With increased rates offered for accredited hospitals, NABH accreditation will become more ubiquitous. Portability and rapid transaction processes will enforce increased levels of technology adoption in the form of maintenance of medical records, disease coding, claim processing and interaction with other stakeholders. With health and wellness centres, preventive care is given the desired push. Furthermore, the scheme will generate magnitude of data

both from healthcare providers and patients, which can be used to create data registries such as National Health Resource Repository (NHRR) and Registry of Hospitals in Network of Insurance (ROHINI). This data can be used to assess epidemiological and treatment patterns, and design and implement better suited health policies.

With a potential to create more than 10,000 jobs immediately, effective implantation of NHPM will also require a new cadre of skilled work force (such as medical coders) and reskilling of existing workforce (such as nurses and lab technicians).

Moreover, setting up of new care delivery institutions in Tier 2 and 3 cities will enforce redistribution of healthcare workforce, which is currently concentrated primarily in metros and tier 1 cities.

Considering the size and magnitude of this scheme, an effective implementation roadmap is imperative for its success.

Concerns around low package rates, infrastructure require-

ments, fraud and leakage management, budgetary and capital requirements etc. needs to be properly addressed. Furthermore, an effective information and communication roadmap needs to be developed to ensure high utilisation of this scheme and help achieve its intended objectives.

PM JAY allows India a historical chance to put in building blocks, which will determine the healthcare of its citizens in the coming decade. Considering the scale and likely impact of PM JAY, it is imperative that the scheme incorporates learning from the other previous schemes implemented in India and in other countries. A successful implementation will ensure that it is allowed to evolve and help achieve the Government’s vision of universal healthcare.

(With inputs from Dr Ashwani Aggarwal - Principal Consultant - Healthcare, PwC. Views expressed are personal)

AB – Translating dream into reality I

ndia spends around one percent of its GDP on public Healthcare, which is one of the lowest proportions in the world. A program of the magnitude of Ayushman Bharat would need a larger outlay and therefore the Government need to provide adequate financial resources to make it operationally viable and sustainable. There is no doubt that if appropriately planned and implemented, it will provide access to quality healthcare to the poor in our Country.

Some of the key factors to be considered for successful implementation of Ayushman Bharat Yojana; 1. Quality - Ensuring quality in healthcare is an important factor and it is commendable that Government is incentivising

quality by paying extra compensation for hospitals with NABH accreditation and those running DNB training programs .In the long run, Government must institute mechanism to audit clinical outcomes of empanelled hospitals, which will set the trend towards enhancing patient safety and ensure quality healthcare.

2. Making Government hospitals vibrant – The Government health Institutions should be made more vibrant with focus on preventive healthcare as one of the prime functions. Reforms in medical education should be fast tracked and sufficient increase in under graduate and post graduate seats should be effected and it should be made affordable. Though the Govern-

Dr. Alexander Thomas, Former CEO Bangalore Baptist Hospital, President AHPI

ment has more than 60 percent of inpatient beds, it is the private sector which provides 70 % of secondary and tertiary care.

This situation must change, ad-

equate staffing and accountability would alter this scenario and Government should become the major provider of health.

3. Financial Viability – At the present time private sector provides majority of secondary and tertiary care and will be the mainstay of the scheme. It should be ensured that these institutions are viable and continue to provide services required. One of the few credible scientific, indicative (costing study) third party verified, involving all stakeholders and the clinical pathway endorsed by the corresponding academic wings of the respective specialities and carried out by the Knowledge Commission ,Government of Karnataka more than a year ago indicate that the present

rates may not be sustainable. It is imperative that far larger study encompassing all the procedures included in the Ayushman Bharat Scheme be planned.

As is being discussed in Karnataka, the Government may consider the possibility of copayment by above poverty line patients. This will also help hospitals in cross subsidising.

Finally the Government should ensure, prompt payment.

Experience with CGHS and even with some of the state government schemes has not been encouraging.

4. Technology - Appropriate use of modern technology is to adopted in order to keep misuse at the lowest level and to ensure maximum utilisation of available resources.

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cover ) Game changer — Healthcare reform T

he announcement of the Ayushman BharatNational Health Protection Mission (AB-NHPM) for the vulnerable section of the Indian population, often quoted as tectonic shift in the healthcare ecosystem of India, is poised to bring abundance of opportunities for indigenous healthcare manufacturers and generate sizeable amount of employment. The scheme will have multiplier impact on healthcare and allied sectors. However, the execution of scheme and sustainable development will be a tall task for the Government of India.

The scheme is innovative and path-breaking, it will help India’s economy, healthcare, and social landscapes to evolve. The standard treatment guidelines and defined packages rates for the hospital will increase the need of affordable and global standard quality solutions. Apparently it will usher domestic manufacturers products to become the preferred choice over high cost imported products. However, to foster innovation

among manufacturers to address the evolving needs of hospitals and caregivers, arbitrary price control mechanisms should not be applied to MedTech products as they become hindrance to innovation and promotion of new technology.

The AB-NHPM scheme is expected to take India towards universal health coverage and it has far-reaching impact on the entire healthcare ecosystem and economy.

In the current healthcare financing, more than 2/3 rd of expenditure on healthcare is out of pocket, the scheme will significantly bring down the out of pocket healthcare expense and have an indirect impact on individual wealth which will lead to economic growth of the nation. The other longer term and most important impact of the scheme will be the data repository through ABNHPM, it will facilitate research and evidence-based decision making in future.

The emergence of the scheme will steer the increase in medical devices consump-

The technology-driven initiative also encourages increased investment in healthcare and generates employment, in abundance

Himanshu Baid, MD, Poly Medicure

tion, as the larger percentage of population will be able to afford secondary and tertiary care which will eventually lead to higher hospital occupancy specially in tier II and tier III cities. This technologydriven initiative also encourages increased investment in healthcare and generates employment, in abundance.

The scheme has its own shortfalls, the overburdened public hospitals, availability of hospital beds and lack enough doctors in the country is abysmal. In India, we have 0.8 physician per thousand people, one of the lowest ratio in the world. India is at least 75 per cent short of the number of qualified doctors it needs.

Thus, even if people are covered under Ayushman Bharat, the quality of healthcare they will have access to remains under a question mark. A recent PwC-CII study lists the needs for a proper monitoring structure, challenges in empanelling hospitals, identifying beneficiary and potential for fraud as risks.

The future after the scheme launch looks progres-

sive and equally challenging for GoI, state governments and the medical device industry could work together on effective procurement and distribution models, to meet healthcare goals and help address the challenges of healthcare access in India.

Providing insurance covers alone will not improve the health system in the country.

Rather, there is a need to build robust healthcare infrastructure in the remotest corners of the country where people have easy access. Budget allocation needs to be increased to realise the purpose of the scheme and hit the ambitious goal of becoming provider to payer and achieve universal health coverage in the true sense.

AB will create a far reaching impact A

yushman Bharat – Pradhan Mantri Jan Arogya Yojana (ABPMJAY), the new health insurance scheme, which will be soon rolled out will significantly improve the healthcare scenario in India and it is expected to change the entire ecosystem in the healthcare space.

The world’s largest healthcare scheme will provide health coverage to more than 10 crore households and 50 crore people will be included in this scheme for `5 lakh per year insurance that will be provided for secondary and terti-

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ary healthcare. The entitlement-based insurance scheme, which has many attractions like IT-enabled, free and cashless in-patient healthcare, will be provided to the people who enrol. We haven’t had such scheme so far that provides this kind of volumes. Being a part of medical devices industry, I am foreseeing a big impact, however, it will not happen in the short-term but gradually and in the next 15 to 20 years, we can expect a double digit growth from our industry.

With 1.25 per cent of the GDP spent on healthcare, pub-

The scheme is an extremely bold decision by the government and active participation of the private players is necessary

Sunil Khurana, CEO & MD, BPL Medical Technologies

lic health is one segment which was majorly ignored for decades together by various governments and with the announcement of AB PMJAY, the focus of India’s public health delivery system is at a centre-stage. The scheme is a

extremely bold decision by the government and active participation of the private players is necessary.

In the coming years, this current government will be remembered for implementing this ambitious scheme.

(

VIEWPOINT

AB will create a new health ecosystem A

yushman Bharat – Pradhan Mantri Jan Arogya Yojana (ABPMJAY) will prove to be a game changer in Indian society and the progressive PMRSSM (Pradhan Mantri Rashtriya Swasthya Suraksha Mission) will ensure cost effective affordable universal healthcare system.

AB – the world’s largest government sponsored healthcare insurance scheme that aims to provide 10 crore of India’s poorest families with health insurance of `5 lakh each per year for secondary and tertiary care hospitalisation, will help to create a new ‘Health Ecosystem’ of universal healthcare for masses. It will also create an opportunity for domestic medical industry to improve efficiency and innovation to provide latest technology and quality products. If utilised properly, this would translate into a blessing in disguise for much coveted but barely moving Make in India initiative for the medical devices industry.

We see significant growth opportunities for the medical devices industry once AB is formally launched on September 25 and are ready to partner with the government in providing the latest technology and best quality affordable products.

For the world’s largest democracy of 1.3 billion, where over 65 per cent of the population has no significant insurance coverage and has been spending out of pocket for medical care, this social welfare scheme will spell widespread transformation in delivery of quality affordable healthcare in the country. I believe that it will help in making India take its place among the most progressive nations.

Our country is at a cusp of realising sustainable higher economic growth and reap the benefits of demographic dividend. It needs a decisive push

needs and quality healthcare which is affordable.

It will take time for the entire system to evolve. There is a need to adopt ‘Reform To Transform’ approach to overhaul existing healthcare system and creating a new set up.

Our suggestions to the government are:

Importance to patient safety

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

and quality affordable healthcare is one such factor which can put India in a higher growth trajectory by ensuring healthy labour force and increased efficiency.

I feel extremely aggrieved when I see that India is ranked 145 among 190 nations, lower than even Bangladesh, Sudan and Equatorial Guinea by the 2018 Global Healthcare

Access and Quality Index. Its time that we change this landscape completely and I believe that AB will help in doing so.

It will help in redefining the healthcare delivery and products with low-cost hospitals, speciality clinics, medical devices costing significantly lower than imported devices, mobile technologies, which address primary healthcare

Focus should also be on universal precautions for patient safety of medical devices such as injections which are widely used and are a major cause of blood borne infections (BBIs) in the country. The government should simultaneously launch ‘Swacch Injection Mission’ to ensure infection prevention in health care procedures.

In India, transmission of BBIs in unsafe healthcare is endemic. According to Indian Programme Evaluation Network Study, 3 to 6 billion injections are administered annually in India. About 60 per cent of these injection are found to be unsafe and 1/3 being reused. Further, poor hygiene in hospitals acts as an amplifier for infections. On a more serious note, we are actually waiting for a catastrophe to happen.

AB, a pan India programme, is a good opportunity for promoting injection safety and hygiene in healthcare procedures. To begin with, the government should

AB, a pan India programme, is a good opportunity for promoting injection safety and hygiene in healthcare procedures.To begin with, the government should make it mandatory to use only auto disable (AD) syringes in the medical treatment. Later on, more advanced safety engineered devices can be used

make it mandatory to use only auto disable (AD) syringes in the medical treatment. Later on, more advanced safety engineered devices can be used.

Here, it is important to note that we are asking to use domestically manufactured AD syringes. So, this will also give a push to domestic medical devices industry and help in actualising ‘Make in India’ mission.

Promote buy Indian policy It will be good if Indian healthcare system for AB has a ‘Buy Indian Preferential/ Price Market Access Policy’ for Made in India medical devices with minimal 50 per cent or higher domestic content and substantial transformation done in India to boost domestic manufacturing.

For medical devices, we need to promote culture of quality and safety and not lowest price, lowest quality as is the case of L1 bidding in government procurement. We believe human life is worth all the efforts to provide quality and safety.

Quality assurance Ensuring quality in healthcare system will be paramount for success of this flagship mission. We suggest granting additional five per cent price benefit for ICMED Certification and two per cent IS:13485 Certificate supplier to reward quality compliant companies in government procurement.

This mission will provide a great impetus for both the government and private healthcare industry to work together towards achieving the nation’s goal of providing universal healthcare. Striking the right balance between rewarding innovation in medical science research and catering to the needs of a nation’s healthcare system would be the key to success of this ambitious mission. raelene.kambli@expressindia.com

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OPINION

Quackery in medical practice: The present scenario MK Chattopadhyay, Retired Senior Principal Scientist, Centre for Cellular and Molecular Biology (CSIR), talks about the need to crackdown on quacks and ways to improve the healthcare system

F

raudulent medical practitioners, who claim to be doctors without studying medicine in a recognised medical college, are rampant in India and some other third world countries. Most of them claim to be allopath, since we generally resort to allopathic treatment when we fall ill. The recent crackdown of police on quacks in Bengal reveals that some of these self-appointed doctors had degree in pure science (e.g B.Sc with physics, chemistry or biology), some had a diploma in homeopathy (mostly earned through a correspondence course run by a unrecognised organisation) while some others had passed only Higher Secondary Examination conducted by the West Bengal Board. How did they venture into the medical practice? Some of them had experience as a compounder (not as a registered pharmacist) in the chamber of a doctor or in the dispensary of a hospital. Some of them were selling medicines in a shop. Some others trained themselves simply by going through some Bengali books on allopathic medicines which are freely available in the market.

The symptom-based prescriptions of these fake doctors may endanger the life of the patient.

When the patient approaches a trained medical practitioner not getting benefited by the treatment of the quack, he finds it difficult to choose the correct medicine since in most of the cases he cannot get any idea as to which drugs were applied to the patient by the quack. Suppression of the symptoms by the symptom-based approach of the quack may also complicate the diagnosis.

Suggested remedial measures: Pros and cons ◗ Legal action against the quacks Quite reasonably, people from different walks of life, are condemning such malpractice in strongest possible terms and urging the government to locate

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the wrong-doers and bring them to the book. Unfortunately, a sizeable fraction of the urban population (including also the educated people) promotes quackery in various ways. When they fall ill, instead of seeking help from a qualified doctor, they approach a local pharmacy. The shopkeeper gives them some medicines based on the symptoms. The dual role played by him as a doctor and as a pharmacist promotes sale in his business. His patient-cum-customer also feels happy to bypass the doctor since it saves a lot of time and money. ◗ Increase in number of doctors Many people believe that we can put an end to quackery by setting up more medical colleges and thereby generating more doctors. The idea is not tenable for various reasons.

First of all, let us examine the feasibility of implementing the idea. Based on a report, provided by the Medical Council of India (MCI), Anupriya Patel, Minister of State for Health, informed the Lok Sabha on July 21, 2017 that less than one doctor is available for 1000 people in India. The doctor:patient ratio in this country is only 0.62. It is far below the ratio 1:1000, recommended by the World Health Organization (WHO). Hence, we require almost double the number of doctors available at present to achieve the doctor:patient ratio recommended by WHO. The government does not have the resource to meet the challenge. Hence, private organisations have to be granted permission in a very large scale to open medical colleges. But it will be extremely difficult to maintain standard and quality of the education and training in those colleges. Many of these colleges may not survive the stringent quality control system of the Medical Council of India (MCI).

Another fact must also be appreciated in this context. Substantial improvement of the

healthcare system may not be achieved simply by increasing the supply of doctors. Investigations performed by two researchers (on the basis of data obtained from 19 countries) at the Centre for Health Services and Policy Research in the University of British Columbia (Vancouver, Canada) indicated that number of physicians in a country might not be a relevant parameter to assess the standard of healthcare [Health Policy Vol 5 (1),pp: 26-31 (2009)]. ◗ Production of rural medical personnel by short-term training Considering the dismal state of healthcare system in rural areas, the Bengal government is mooting the idea of providing training to some of the village doctors (having no formal education or training in medical practice but working as doctors) so that they could take care of the health problems of the villagers to some extent and timely refer them to a qualified medical practitioner or hospital. Earlier, a proposal was raised to reintroduce the Licentiate in Medical Faculty (LMF) course in Bengal. But it could not be implemented because of strong opposition by the doctors.

However, the idea is neither new nor anything outlandish. A similar scheme was implemented in China during the second half of the last century. Usually students, who graduated from the secondary schools,

were chosen for the programme.

They were trained in a hospital (usually for six months) on prevention of epidemics, treatment of diseases that were generally found to affect the villagers and use of some western medicines and techniques. Qualified doctors were sent to the villages to train these ‘barefoot doctors.’

The trainees were generally farmers and while receiving the training, they were allowed to do their work in their farms. The scheme was successful in providing healthcare in the rural areas in an affordable cost and it earned accolade from WHO as a ‘successful example of solving shortages of medical services in rural areas.’ ◗ Deregulation of the prescriptive right The issue of prescriptive right (the legal right to write a prescription) needs serious attention and reconsideration in the Indian perspective. In this country, the right is confined only among the registered medical practitioners, who cry foul whenever any proposal is raised for deregulation of the right. But even in the US, the right is deregulated to some extent. According to the law of some states, nurses and advanced practice registered nurses (e.g certified nurse-midwives), have the power to write prescriptions.

Veterinarians and dentists also have prescriptive power in all the 50 states. Even clinical pharmacists are given the authority within some defined limitations to write prescriptions in some states. There is another type of health workers called Physician Assistants in the US. They are meant for prevention and treatment of human illness and injury by working under a supervising physician. Following extensive clinical training, similar to the training of the medical students but shorter in duration, they are licensed to work in hospitals, clinics and other types of healthcare facilities. They have also authorised to write prescriptions

within some limitations, defined by the law of different states.

Physician assistants are found also in Canada and known by the designation Physician Associates in the UK. Similar programme is undertaken in Australia and New Zealand to help the rural healthcare system.

Effective management The potential of a training programme involving village doctors as an effective short-run strategy to improve healthcare in the rural areas of Bengal was demonstrated in a recent study published in the premier journal Science [Vol 354, (6308), aaf7384 (2016)] led by Dr Abhijit V.Banerjee, a Ford Foundation International Professor of Economics at MIT, US. Hence, the aforementioned scheme proposed by the Bengal appears to be a practicable approach. The government emphasises that the scheme will not only provide primary healthcare to the villagers but at the same time will help minimise the indiscriminate practice of the quacks, who have no accountability. If any one of the trained health workers violates his limit (applies medicines that he is not supposed to use or performs surgical operation), he could be easily tracked down and punished. It is also noteworthy that even in the developed countries, the policy-makers have come to terms with the reality that effective management of the healthcare system may not be possible only with the help of qualified medical personnel and some amount of deregulation of the right to see patients and prescribe medicines is inevitable for this purpose. So instead of maintaining a sacrosanct attitude about the medical profession in one hand and throwing the door wide open for the untrained quacks on the other hand, let us think of the alternatives which are working well in other countries.

KNOWLEDGE

Living with diabetes in the newage Dr Monashis Sahu, Fellow, American College of Endocrinology elaborates on insulin therapy and the various ways of administering it to manage diabetes effectively

K

avitha, a 52-year-old teacher was prescribed insulin for her uncontrolled diabetes. It made her feel angry as well as disturbed. Fear of insulin injections and feeling of guilt overwhelmed her.

Like Kavitha, there are many people who fear insulin and try to avoid it at the cost of their health. It was not surprising to me as 50 per cent of my patients are reluctant to start insulin in the beginning.

In fact, data from several studies indicate that 27 per cent to 73 per cent people with type 2 diabetes are reluctant to start insulin at beginning.

Insulin is a natural hormone produced by our body, lack of which in body causes diabetes. It is vital for the treatment for many people with diabetes. Relatively, a large percentage of world population, around 425 million people (IDF- 2017), is affected by diabetes mellitus.

Out of which approximately 510 per cent are with type 1 diabetes while the remaining 90 per cent are with Type 2. For people diagnosed with type 1 diabetes, insulin is essential for life as body does not produce insulin at all. In case of Type 2 diabetes where there is a progressive destruction of the insulin-producing beta cells, most people eventually require insulin to attain their blood glucose levels in target range.

Research has shown that there is definitely benefit of early insulinisation in preventing complications and providing a better quality of life for people with diabetes.

However, many people with type 2 diabetes like Kavitha are reluctant to start insulin even when it is utmost essential, for a number of reasons including fear of injections.

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KNOWLEDGE This is where the role of education, awareness and counselling comes in.

Insulin as a medicine cannot be taken by oral route as pills as it gets destroyed in the gastrointestinal tract, although research is going on for this option on a rapid pace.

The traditional and most predictable method for taking insulin is by subcutaneous injections, in layer of fat between the skin and the muscle. Historically, people with diabetes injected insulin using glass syringes with detachable needles. These needles were large, and injections were painful. However now a days, if one’s diabetes treatment plan includes insulin therapy, one can choose between various insulin delivery devices. For increased compliance and comfort of people with diabetes many insulin delivery devices have been developed, including insulin pens and pumps.

Insulin Injections: Today, insulin injection syringes available in the market are derived from plastics, are light in weight, disposable and have fixed micro fine needles.

These syringes increase patient comfort and offer convenience, still many people find syringes daunting and not very convenient.

Insulin pen injectors: These are a convenient way of administering insulin. The first insulin pen (Novo Pen) was introduced by Novo Nordisk in 1987.

Many pens are available since

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Nowadays, if one’s diabetes treatment plan includes insulin therapy, one can choose between various insulin delivery devices then in a variety of types and shapes. Pens offer not only, comfort and accuracy but also convenience to use and carry since they combine the insulin container and the syringe into a single unit. The pens are discreet and popular as one can carry them along with them without anybody noticing.

There are two main types of pens, one that is reusable and the other a prefilled device. In the former case, the patient must load an insulin cartridge prior to use. Reusable insulin pens offer a wide range of advantages such as their durability, cost effectiveness and eliminating the need of cartridge refrigeration and flexibility in carrying three to fiveday supply. The prefilled

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insulin pens are smaller in size and lighter in weight. Prefilled pens are ready to use, eliminating the step of loading insulin into the delivery device. Pen causes minimal pain due to the finest and shortest disposable insulin needles. The needles for pens are available in varying lengths (from 4 mm to 8 mm) and varying gauges (from 29- to 32-gauge; the larger the gauge number, the smaller the diameter of the needle bore).

External insulin pumps: These are small devices the size of a pager that can be attached to your belt or placed in pocket. An insulin pump delivers infusions of insulin through a catheter placed in the layer of fat under the skin of abdomen. The catheter

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needs to be changed every two to three days. Pump is programmed to deliver a continuous (basal) dose of insulin and supplemental (bolus) doses before meals. Although insulin pumps provide accuracy and greater flexibility in insulin delivery for patients according to their individual requirements, one needs to check his/her blood sugar level every three to four hours to determine how much insulin one need.

Pump is advantageous for people who do not like injections as it is only necessary to insert a needle once every three to four days. insulin patches, insulin sprays, either for the nose or mouth, and oral insulin (insulin pills) are methods of insulin

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delivery that continue to be investigated. These options along with stem cell transplant represent long-term possibilities for insulin delivery, as difficulties in obtaining adequate amounts of insulin in the bloodstream are yet to be overcome.

Education about all aspects of managing diabetes and counseling about living with the disease is essential.

It is important that patients are given the opportunity to handle the types of devices available and choose the one that best suits their need for better compliance. Most trials indicate that insulin pens are a widely accepted, economical and accurate device for taking insulin. Users just need to turn a dial to select the desired dose of insulin and press a plunger on the end to deliver the insulin just under the skin.

Thus, insulin pens can be called as a new bottle for old elixir.

When taking insulin is essential, insulin delivery devices like pens play the role of a friend for people with diabetes. Kavitha also accepted the pen and by taking proper doses of insulin along with diet and exercise management, she felt that her own self was back with more energy and happiness, she felt more healthy as well. It is very essential for management of chronic diseases like diabetes; one must accept the situation and many wonderful solutions are here to assist the person.

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KNOWLEDGE I N T E R V I E W

'I am hoping that the first batch of devices will be available in 24 to 36 months' Bengaluru-based Dr Rajesh Palani has developed a non-invasive medical diagnostic device that analyses bodily sounds to diagnose multiple medical conditions. He has also received a patent from the USPTO for this device. In an exclusive interview with Lakshmipriya Nair, he speaks on how the device can serve unmet healthcare needs and divulges his plans for making the device available globally and at an affordable price Can you give us an overview on the evolving diagnostics requirements of the country?

According to Make in India’s website, the medical devices industry in India is currently valued at $5.2 billion and growing at a CAGR of 15.8 per cent. A component of this is diagnostic equipment.

According to a media report, India accounts for just one percent of the global diagnostic industry which is growing at a CAGR of 20 per cent and expected to reach $32 billion by 2022. With India having the world’s second largest population and the highest disease burden, the cost of healthcare will continue to grow, putting a lot of pressure on our resources. The need for cost-effective, accurate and early diagnostics is therefore extremely important and critical for a country like ours.

Take TB, which is the ninth leading cause of death worldwide, as an example.

WHO says that an estimated 53 million lives were saved through TB diagnosis and treatment between 2000 and 2016. For a diseases whose social and economic cost is high, early diagnosis and treatment of TB can not just save lives but also save resources that could be allocated to other healthcare priorities. We therefore need more investment in researching diagnostic devices to meet the unique healthcare requirements of our country.

Presently, TB diagnosis is based on a sputum examination under a microscope, or by culturing the sample. A chest Xray may also help in diagnosis.

More recently, the Gene Xpert technique is being used to diagnose this deadly disease.

However, the microscope exam is not 100 per cent reliable and sputum culturing is time consuming and takes weeks to get a result. Although Gene Xpert is capable of producing results in minutes, it is very expensive and not easily available. None of the above mentioned diagnostic tools come handy as a handheld device. Hence, there is a need for a cost-effective, improved, fast, handy diagnostic and screening tool that will help in the diagnosis and epidemic screening of tuberculosis.

You have developed a handheld diagnostic device. Tell us the science behind it. How does it operate?

Just as one can find the fuel level of a motorcycle by percussing its fuel tank and assessing the sound it produces, similarly, for about 400 years doctors have been using the percussion technique on certain anatomical areas (example the chest) of a patient during physical examination to get a diagnostic clue based on variations in the resonated sounds. My device has a mechanism that produces percussion sounds when placed on a patient which is then analysed by an in-built analyser and the results are then displayed on a screen.

What inspired you to come up with this diagnostic device?

As a doctor, and on humanitarian grounds, I have an innate interest in finding affordable solutions for

epidemic diseases common in underdeveloped and developing countries. It all started back in med school (JJM Medical College in Karnataka, India). One morning, while performing the percussion technique on a patient as part of a physical examination, I got the idea of using resonant sounds from the human body to develop an economical, diagnostic medical device. I developed the first prototype in 2003 — which occupied an entire table — with a rotating drum to record the resonant sound readings.

When I created this first prototype, I realised that further modifications to this device could potentially lead to a novel, handheld screening device for respiratory diseases.

How does it meet an unmet need in Indian healthcare?

Can it applied for different therapeutic areas?

India has a need for affordable medical devices to address diseases that are common in our country. For example, as per WHO, India accounts for about a quarter of the global TB burden and has the highest

burden of this disease1. There is therefore a need for a rapid, handheld, economical TB diagnostic/screening tool.

Since the device is pocketsized, works quickly and safely, and is economical, it has the potential to be a mass screening device for many respiratory diseases like pneumonia or tuberculosis. As it is very economical, this device can also be used in primary healthcare centres and rural hospitals. In an emergency, this device could come in handy to diagnose pulmonary edema, pleural effusion in heart failure condition, etc. In a war zone, it can be used to diagnose warfare chest injuries, like hemothorax.

Physicians/medical students can use the device as a better diagnostic tool and as a replacement for the percussion technique in the physical examination of patients. A stethoscope is for auscultation sounds — or sounds from the heart, lungs, or other organs — while this device is for percussion sounds, or how the sound resonates to determine the underlying structure. My hope is that a day will come when I see a stethoscope around a doctor’s neck, and my device in the pocket.

This device is yet to be clinically tested. The complete potential of this device will be realised once we do clinical trials. Since this device is based on the analysis of differences in resonated sounds, I hope all the different diseases and medical conditions that produce variations in resonated sounds by nature can be diagnosed

using this device.

How will it disrupt or transform diagnostics to improve it efficacy, accuracy and affordability?

For a medical device, size, cost, accuracy, portability, simplicity, speed (rapid testing) and safety matter. This device is developed based on all these considerations. For example, I hope this device will provide better results to screen respiratory diseases like pneumonia and pulmonary TB as compared to the age-old sputum analysis test. It is also safer than X-rays, and hopefully will be the cheapest of all available screening devices, thus reducing the global economic burden due to these diseases.

What are your go-to-market strategies for this product?

How soon do you plan to commercialise it?

One of the important objectives of this invention is to make it affordable for people in underdeveloped and developing countries. Hence, different strategies will need to be implemented for different geographies.

For underdeveloped and developing nations, the focus will need to be on public-private partnerships, partnership with global public health agencies, other NGOs, CSR initiatives and other strategic partnerships. For developed nations, strategic partnerships, branding and distribution will be key. I am hoping that the first batch of devices will be available in 24 to 36 months. lakshmipriya.nair@expressindia.com

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START UP CORNER I N T E R V I E W

We see great synergies with government’s emphasis on women health NIRAMAI, a tech startup has developed an innovative early breast cancer detection technology for women of all ages. Dr Geetha Manjunath, CEO & CTO, NIRAMAI elaborates how the solution can be effective in improving the reach and accuracy of breat cancer screening, in an exclusive interview with Lakshmipriya Nair How is Niramai’s solution disrupting the healthcare space? What does it solution do that hasn’t been done hitherto?

NIRAMAI has created a disruptive solution to determine breast health and detect early stage breast cancer. There are several gaps that exist in the current methods of performing breast screening today that NIRAMAI is poised to eliminate. Mammography works only for women over 45 years while recent times has seen increased prevalence of breast cancer in younger women who do not have an effective cancer detection method. Most cancers are first detected through clinical breast examination as lumps, but by the time these tumours are palpable, the cancer can be in stage 2 or 3. Many lumps are not cancerous, so there is false alarm. Another important issue for which women shy away from doing breast screening is the requirement to disrobe in front of others, be it even a female technician.

NIRAMAI addresses all of the above issues.

NIRAMAI has developed a novel non-contact, noninvasive solution for breast screening that works for women of all age groups and anyone over 20 years can undergo frequent screening without any side-effects of radiation. It has the ability to detect abnormalities at an early stage and in a very privacy manner where there is no touch, no radiation, no pain and in fact no one sees the person during the test.

We have developed novel

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machine intelligence-based software that analysis heat maps to detect breast abnormality. We call this technology as ‘Thermalytix’ and we have six granted US patents and many more pending patent applications for the innovation.

How do they serve the needs of Indian healthcare in terms of accuracy and affordability?

Large scale adoption of a screening solution for Indian women needs to be affordable, accessible and also automated. NIRAMAI diagnostic solution is one third cost of a mammography available for about ` 1000, while NIRAMAI mass triaging solution for low income group is available at `100 per person.

The solution has been proven to have good accuracy and that makes it possible to use low-skilled health workers to perform real-time screening and triaging to identify women that need to be brought to a hospital for further tests through population screening.

NIRAMAI clinical trial results have been published in international journals. The solution has 27 per cent higher accuracy than mammography with high sensitivity of 97 per cent on women, and works even on dense breasts. We have also compared the solution with traditional thermography and find an increase of 70 per cent higher predictive value than manual interpretation. NIRAMAI solution has both sensitivity and specificity above 95 per cent.

Your website describes that your solution for breast cancer screening can detect tumors five times smaller than what clinical exam can detect, yet is noncontact, painless and free of any radiation. So, can you explain how it works?

Instead of looking at breast mass or lump, which needs to be atleast 2 cm in size to feel it with hand, NIRAMAI solution analyses the heat distribution in the breast to detect very small breast abnormalities. NIRAMAI Thermalytix solution uses a high-resolution thermal sensing device to scan the chest area at three feet from the patient, and patented algorithms to analyse the thermal images to generate a provisional diagnostic report. There is no touch or radiation involved in the process.

What are your plans to market this solution? Do you have tie-ups with hospitals and clinics?

NIRAMAI aims to expand the availability of breast health screening solutions to women, and for that purpose we work with various stakeholders including hospitals, diagnostic centres, individual practitioners, NGOs, government, corporates etc.

We work closely with medical community for bringing our solution to women. Our solution is available in more than ten hospitals and diagnostic centres in Bengaluru, Mysore, Pune and Dehradun, and we continue to add more locations. We provide end-to-end solutions to the institutions, including equipment, training, report generation, and doctor certification service to those centres.

We also work closely with gynaecologists and general practitioners who are very often the first touchpoint for women seeking medical advice regarding breast health issues.

Are you exploring any tieups with the government to make breast cancer screening more easily available and expand your reach?

We see great synergies with government’s emphasis on women health. Breast cancer is the largest cause of cancer deaths among women and those deaths are preventable by early screening. We believe our portable, automated screening solution with real time reporting, is a great fit for population screening

programmes. We are actively exploring joint programmes with various government agencies, health ministry initiatives and government hospitals to provide quality care to those who have limited access to healthcare.

We recently won a grant award from BIRAC. NITI Aayog is also very supportive of our AI-based healthtech solution. We are hoping to get the support and mentorship from both these organisations to take the solution to the government.

Both the co-founders of NIRAMAI have a background in technology, what made you venture into healthcare?

Both Nidhi and I have seen breast cancer in our families and suffered from lack of good technology for accurate screening in early stage of malignancy, which was an inspiration to start NIRAMAI. The trigger to start working on this technology research problem was when I (Geetha) lost two of my young cousin sisters to breast cancer due to late detection. I was a senior director in a corporate innovation team at that time.

Since me and my team had the knowledge and experience of applying AI to multiple real problems, we wanted to first experiment use of AI on radiological images to come up with a new solution to address the issues with early screening. We are glad to see the four year research showing promising results today on about 3500 women. lakshmipriya.nair@expressindia.com

TRADE AND TRENDS I N T E R V I E W

Driving better patient outcomes in India Tim Morris, Products and Partnership Director, Elsevier, in an interaction with Sanjiv Das, gives an outlook on the Indian healthcare system and the company’s vision to help healthcare providers deliver higher quality care and better outcomes for patients

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What are some key challenges and opportunities for India’s healthcare system?

The health of India’s population is marked by a ‘dual disease burden’ — a continuing rise in communicable diseases alongside a spurt in noncommunicable or ‘lifestyle’ diseases.

This means a growing demand for healthcare, which is placing immense pressures on India’s existing health infrastructure. At the same time, hospitals, particularly public providers, see high rates of hospitalacquired infection, which are often fatal even though avoidable. This is driven by irregular adherence to practice bundles, lack of administrative and financial support, hospital overcrowding and low doctors-to-patients ratio. Beyond these challenges, the Indian healthcare system has long been characterised by high out-of-pocket expenses due to low government spending. According to the National Health Policy (NHP) 2017, over 63 million persons are pushed to poverty every year due to healthcare costs.

With PM Narendra Modi’s recent announcement of the new National Health Protection Scheme (NHPS) however, it is evident that the Indian government is serious about providing affordable healthcare for more Indians nationwide. While cost and coverage of care seems to be at the heart of this initiative, it is important that raising

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Messe Duesseldorf India Pvt.Ltd. Centre Point 7th. Floor Junction of S.V. Road & Juhu Tara Road, Santacruz West Mumbai 400 054 Tel. (0091 22) 6678 99 33 _ Fax (0091 22) 6678 99 11 messeduesseldorf@md-india.com

TRADE AND TRENDS the quality of care in India remains a joint priority.

While the government’s push for national electronic medical records (EMR) adoption is a step in the right direction, EMR alone has limited impact in reducing medical errors and improving outcomes. Including Clinical Decision Support (CDS) Solutions in clinical workflows gives EMR the power to guide healthcare professionals in making the right, evidence-based decisions at all points of care.

What are your plans for the Indian market?

India is a growing market for us. Apart from working with EMR vendors in India to provide clinical decision support tools for doctors at the point of care and supporting nurses with care planning tools, we hope to work more closely with the

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Indian government, various agencies and NGOs to be a part of the solution addressing the overall health condition of India.

Recognising the power of data to help healthcare professionals make more informed decisions about patients’ care plans, we have invested in AI deep analytics and Machine Learning. These sophisticated capabilities allow raw patient/health data (which are amassed on a daily basis) to be transformed into real-time actionable insights that can be fed back into practice. We invite partners from both the public and private sectors to share in our vision to deliver better patient outcomes through the use of these new technologies.

We are in over three major cities in India, including Mumbai, Chennai and Delhi, with close to 1,000 employees.

Our Chennai office alone has

about 600 - 700 employees.

Our global team provides support to local offices by relaying experiences and best practices gathered from across the world.

Any plans to tie up with the Indian government.

Absolutely – we are extremely excited about where the Government of India is going in terms of their health blue print. The National Health Policy (NHP) 2017, advocates extensive deployment of digital tools while ensuring interoperability between IT systems for improving the efficiency and outcomes of India’s healthcare system. At Elsevier, we believe that India has a huge opportunity to use its rapidly developing digital infrastructure to bridge knowledge gaps, increase capacity, and bring better care to all, whether they reside in the ever growing

mega-cities or in suburban/rural areas.

We are particularly keen to partner the Indian government in their goal of bringing quality care to more patients in the underserved rural areas, where millions of people still reside.

We are currently looking at projects that could support care providers in these less urban areas in the long-term condition management of heart disease and diabetes.

There are also several ongoing programmes in collaboration with local governments to introduce digital health solutions to current care processes.

Tell us more about what Elsevier does.

Elsevier is an information analytics company and one of the world's major providers of scientific, technical, and medical information. We have

a 193 year history of providing health information to doctors and nurses across the globe, 20 years’ experience in big data and are a trusted partner in integrating technology with world-class content in 24 countries. Our health and clinical solutions offerings are in the areas of strategic research management, R&D performance, clinical decision support, and professional education. In the area of clinical decision support, we curate clinical information, databases, intelligent search tools and mobile technology to enable healthcare professionals to improve clinical outcomes through evidence-based care. As an analytics company, we are also working on machine learning and AI to deliver solutions for doctors. sanjiv.das@expressindia.com

TRADE AND TRENDS I N T E R V I E W

‘We are developing a tool that will take care of procurement of medicines and medical devices’ Vivek Tiwari, CEO, Medikabazaar, shares his views on medical procurement systems followed in India and talks about his business plans for healthcare Tell us about your current business expansion plans?

We have six full-fledged fulfillment centres and we do business across 16000 plus pincodes in India. We have 15,000 medical centres across tier II and III cities and around 50,000 doctors have also registered on our portal.

Primarily, we do B2B transactions. So on a unit economic basis we are a profitable company and growing as well as spending heavily on our expansion. We are soon going to raise our second round of funding and that is how our scale of operation will move further.

Who are your current investors and who will be your investors in the second round?

So in pre-series A our venture partners were Rebright partners- a Singapore and Japan-based VC company, two Indian angel investors-Sunil Kalra and Arun Venkatachalam. These are two very active healthcare start-up funders who fund Series A to Pre-series funding.

Our current investors will also be part of second round of funding with a few more international and domestic funds. We are planning to raise around $6-8 million.

These funds will be utilised for domestic expansion.

Are you looking to expand your business abroad?

India is a huge market and I feel we haven't yet touched its surface. We will not look at expanding abroad.

general algorithm.

Why do you think AI will be a great enabler here?

Procurement has to be based on a hospital’s consumption pattern and not on assumption. AI will help in dissecting and tracking the consumption patterns of each hospital and then provide data which is more relevant as well as give a clear picture of the demand. So, this is based on predictive analysis which will help organisations to understand their real needs and can build a systematic process. It will also help organisations build an efficient inventory management system resulting in better performance outcomes.

There are many healthcare digital platforms coming up in the B2B space. How are you carving your niche?

We are a vertical B2B player.

We do not consider ourselves as horizontal B2B business.

Our focus is into the healthcare space, predominantly in the medical institutions. We believe that this segment has immense scope for future development.

It is a very engaging segment where customers’ focus plays a major role in determining the success of platforms such as ours. We are also looking at expanding our services to become a full-fledged service provider and not just a market place. We are looking at getting the procurement business as well-both devices

and pharmaceuticals. It has great market growth which will add value to our current business. So, I think that is our differentiator.

Tell us about your plans in the procurement business.

We are developing a tool that will take care of procurement of medicines and medical devices.

It will help hospitals manage inventory and rationalise their working capital. In India, procurement planning is really bad. There is no standard system in place and so systematic procurement planning, execution and inventory management will enable the industry to bring in the much needed standards. I feel that the industry needs a system based on AI and not

How does your procurement platform impact the operating cost of hospitals?

We will provide this service for free. This is a full line value add service that we will offer to our customers. Which is why I spoke about engagement, this service will not only allow them to buy products, but will also allow them to manage their inventory, reduce the cost, in turn helping them to make profits. The share of medical supplies within a hospital accounts to around 15-16 per cent, not counting pharmaceuticals and medical equipment. Manpower has the highest cost component.

Well, hospitals can't reduce their cost on manpower but even a cost reduction of 1-2 per cent on unwanted medical

supplies will make a huge difference on the bottom line.

Indian hospitals today are struggling to manage finances. How do see their inventory cycles impacting their bottom lines?

Sometimes, hospitals end up buying so many supplies which they may not even require. If these hospitals do a deep down analysis of their inventory cycles, they will understand that few items have been bought for years and few items do not last for a week. So, if you do a rationalisation of their inventory, one will come to the realisation that hospitals are blocked with huge inventory and corresponding working capital. If that can be released and rationalised then surely it will boost their profit margins.

So, how does a company like Medikabazar improve procurement systems within the public health sector?

We want to help government in making better procurement decisions with more awareness and help tender authorities with price validation systems. We think government through our platform (medical devices tender validation tool) can build a strong and quality procurement system.

What we offer is a systematic, transparent process that connects each link in the procurement system; making the process efficient, cost-effective and resourceful.

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TRADE AND TRENDS

Committed to Make in India BPL Medical Technologies is committed to continue to carry forward the brand legacy of BPL and be the preferred and trusted medical device company, setting highest standards while delivering affordable solutions with a commitment to customer centricity. Praveen Nagpal, COO, BPL Medical Technologies reveals more CURRENTLY, INDIA is counted amongst the top 20 Global medical devices market, valued at $3.5 billion in 2015 and growing at a Compound Annual Growth Rate (CAGR) of 15.8 per cent. There is an increased disease burden and an ageing population. Further, an increased disposable income and an improved healthcare awareness would only drive this industry forward. The government has also started taking encouraging steps towards building a sustainable and quality healthcare infrastructure in India. The recent liberalising of government policies, while increased encouragement towards a Foreign Direct Investment is seen as a positive. Incentives for setting R&D facilities, creation of designated manufacturing zones for medical devices, PPPs, and Ayushman Bharat Yojana are few of the great opportunities for device manufacturing companies.

Make in India, a programme was initiated with an objective of fostering innovation, setting R&D culture and to encourage skill development. Companies are thus encouraged to build world class manufacturing units within the country. The primary goal was to develop and strengthen the manufacturing sector by making medical devices and healthcare delivery in India much more affordable and accessible to the people. This should change the current scenario of approximately 80 per cent medical imports in country to a high percentage of using ‘Made in India’ medical products.

BPL Medical Technologies has been manufacturing medical devices in India since 1967, when it launched its first ECG machine. We are continuously striving towards being ‘The Indian Multinational’ and at same time wanting to establish a strong foothold across India.

We are now manufacturing

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ECG machines, defibrillators, patient monitors, C-Arm, Xrays, critical care products and many other devices at our manufacturing unit in Kerala. We are continuously looking to add many more products through sustained R&D efforts and innovation. To ensure the good quality products reach the customers, manufacturing in India needs to go through stringent processes and checks, e.g.

Choosing the right design, quality components, the right facility for production, updated quality check protocols and continuous ISO audits. This ensures that the standard of products is equivalent or better to the ones being imported. All products at BPL Medical adheres to such stringent process checks and pass safety and regulatory compliances.

At BPL Medical Technologies, we are committed to continue to carry forward the brand legacy of BPL and be the preferred and trusted medical device company. We are setting high standards while delivering affordable solutions with a commitment to customer centricity.

Our latest product portfolio spread across six verticals Viz cardiology, critical care, women and child, imaging, home health and consumables is a testimony to the fact that BPL wants to come across as a major Indian

medical device manufacturing and solution provider. As an Indian medical device company, we understand the needs of our customers and are incorporating their feedback in our Product development cycle, thereby developing these products, well suited for the Indian healthcare ecosystem.

Some of our technology partnerships across the globe are from the US, the UK, Japan, Korea and Germany. Such partnerships are key to provide highly reliable and feature rich products. While developing new products, we not only consider patient safety but also focus on clinician safety. Our Xray and Carm machines with a cutting-edge technology, emits minimum scattered dose of radiation for the patient and the clinician. This safeguards the health of both and qualify as a world class product. Our Glasgow interpretation on ECG devices is one of the finest interpretation available across the world and comes with more than 25 years of clinical relevance. There have been significant efforts to ensure that our products are technology and quality driven, while creating value for the customers. We are working very closely with certifying and auditing agencies to make sure our quality standards are optimally maintained.

BPL is an ISO13485-2016 certified company and all our functions do follow the quality, safety and production standards prescribed for individual medical device companies.

We have been able to penetrate and reach the semi urban, tier II and tier III cities of India which consists of more than 60 per cent of the population. This provides a huge opportunity for the medical device business. A distribution network of more than 90 dealers across India, and some of them working with BPL since inception is helping us reach distant locations in India. Our service network is an added strength and under SMART UPKEEP initiative, various solutions are provided to our customers. We have a dedicated call centre working six days a week and connect with customers to ensure product life cycle is well utilised.

With more than 200 dedicated and skilled service staff across the country, we remain close to our customers and provide them with end to end solutions.

This includes right consumable and accessories that increases the life of the product.

To increase our global footprint, we have also invested outside India. Penlon is a whollyowned subsidiary of BPL Medical and is located at Oxfordshire, UK. This facility pro-

duces one of the best anaesthesia work stations and vaporisers among other products. They have recently celebrated their 75th anniversary. They have a distribution network in more than 90 countries which would also be key for BPL Medical to serve beyond India. The acceptance of our products in the international market is overwhelming. We are currently increasing our distribution network. We are optimistic about the potential and the growth we can achieve in the export business and being called an ‘Indian Multinational’ company.

As a medical devices and solution provider company, we always strive to provide more for the people of this country. This is possible with increased efforts on product development.

It can be fast tracked with more engaging platforms emerging from universities to partner with us on innovation, both technically and clinically. The government should provide infrastructure for clinical validation labs to develop new technology in India. This will take Indian products to the highest quality and patient safety standards and even increase export opportunities.

We would also need infrastructure to provide Indian made components for better value and medical certification facilities to quickly test the products while development.

We are seeing an increased support from the government towards domestic manufacturers for public procurement. This is a welcome step to boost growth.

We believe that healthcare in India is at an inflection point whereby we will see exponential growth in the coming years to build a sustainable healthcare delivery infrastructure.

BPL Medical Technologies is well placed to support the healthcare delivery with effective patient outcomes.

TRADE AND TRENDS

Kohinoor Surgicals launches LED OTLights NOWADAYS LEDS are used in surgical operating room lights. Earlier halogen or incadascent filament bulbs were in use. Manufacturers used magnifying plastic lenses with LEDs to get the maximum intensity during surgeries. Due to high and heavy light intensity shower / rays and heat, while performing long time surgeries, many surgeons used to face eye problems like ‘cataract’ and ‘Macular degeneration.’ It led to loss of vision in some while others faced hardships to recognise colours etc. Macular degeneration is considered as an incurable eye disease.

Macular degeneration is caused by deterioration of the central portion of the retina, the inside back layer of the eye that records images one

Kohinoor Surgicals uses multifaceted multireflectiors with diffuser in LED OT lights

sees and sends them via the optic nerve from the eye to the brain. The retina’s central portion, know as the Macula, is responsible for focussing central vision in the eye, and it

controls the ability to read, drive a car, recognise faces or colours and see objects in fine details.

To prevent this and as a precautionary measure, Kohinoor Surgicals uses multifaceted multi-reflectiors with diffuser in LED OT lights i.e.

Kohinoor Surgical’s brand OT lights. It gives optimum and smooth light beam and focusses from different angles to minimise shadows and give a cool light intensity at the surgery site. Hence the surgeons were comfortable while performing surgeries.

Contact details Parasmal Jain Kohinoor Surgicals Mumbai 9833897760 / 8369705787 kohinoorsurgicals.co.in

Rosalina Instruments develops RadTag indicator RadTag indicator Was developed to meet the regulatory requirements to confirm that the delivered dose of radiation is within safe ranges. Is the only indicator that confirms the range of dose delivered meets both minimum and does not exceed maximum dose range.

Quality certification RadTag Blood Irradiation Indicators are manufactured by RadTag Technologies in compliance with ISO 9001:2015 guidelines.

RadTag Blood Irradiation Indicators are registered Class I medical devices with the FDA and under Health Canada guidelines.

It’s simple, but tells you more The product can be simple to use if the end user is only looking to see if there is a colour

change.

However, regulatory bodies have recommended dose ranges for the safe irradiation of blood and blood products.

RadTag®is the only indicator that can give you this information. It tells you more, It tells you whether you have underirradiated or over-irradiated the blood product. Designed for organizations that require an additional level of safety assurance.

Reasons for choosing RadTag ◗ It’s simple, but tells you more. ◗ Can be used as a YES/NO device, but also verifies dose range to meet European/UK/AABB guidelines for minimum and maximum doses. ◗ Is flexible to adhere to syringes (used in neonatal applications).

◗ Both Gamma and X-ray versions available. ◗ Onlyindicator that reveals that the range of dose delivered is within recommended limits for blood and blood components (25 Gyto 50 Gy).

◗ Printed lot number (barcode) and expiration date. ◗ Quick turnaround time for orders. ◗ Committed to quality and customer service.

Contact details Rosalina Instruments 127, Bussa Udyog Bhavan, Tokershi Jivraj Rd, Sewri Mumbai - 400015 Phone: 91-22-2416 6630 / 2417 3493

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TRADE AND TRENDS

vTitan: The next generation innovative medical devices company vTitan Corporation was born to build high-quality healthcare products in India, for the world.

Peri Kasthuri, CEO, vTitan Corporation, reveals more INDIAN MEDICAL devices market is currently valued at $ 4 billion and is expected to expand to $12 billion by 2023.

India relies on imports to supply its healthcare system with latest medical technology; and currently imports almost 80 per cent of medical devices. As India’s economic, healthcare, and social landscapes evolve, its medical device market is attracting foreign manufacturers.

To change this paradigm, vTitan Corporation was born to build high-quality healthcare products in India, for the world. vTitan Corporation, is a multinational company based out of India, US and Singapore. vTitan is an end-to -end engaged in the design, development, manufacture and sales and support of innovative world-class medical devices in critical care space that would aid hospitals to improve patient outcomes in line with our motto ‘Safer Healthcare for Everyone.’

Building the know-how and skill-sets in India, which is very much essential for designing and manufacturing medical devices requires time, patience, endurance and persistence. What started out as a small dream has transpired into an 80 + engineering centric design and manufacturing company today. vTitan has recently launched Accuflow SP-550 and IBP-550 Syringe Infusion Pumps for critical care medication administration. The pumps are powered by indigenously developed and patented closed-loop motion control technology. This technology aids in accurate delivery of drugs to critical care patients. The Accuflow SP-550 is designed to be used in hospitals with uninterrupted power

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Peri Kasthuri, CEO, vTitan Corporation

These devices aid hospitals and healthcare professionals to improve treatment efficacy and patient outcome in critical-care cases.

Peri Kasthuri, Co-founder and CEO, vTitan Corporation, said, “At vTitan, we believe in creating a culture where employees embrace advanced technology to develop innovative and superior products, with the philosophy of continuous improvement catering to dynamic global market requirements. We aim to make

About vTitan Corporation vTitan Corporation provides

innovation-centric, technology-driven global medical devices and solutions. vTitan is a privately-held company, headquartered in Chennai, India and Pleasanton, USA, with an office in Singapore.

The company aims to offer next-generation, safer, accessible and affordable medical devices for critical-care medication. With over 80 employees in India, vTitan aims to transform healthcare sector by providing advanced solutions for patient care and treatment. The company currently manufactures infusion pumps powered by indigenously-developed and patented closed-loop motion control technology.

Contact details https://vtitan.com/ Follow on Facebook, LinkedIn and Twitter.

vTitan Corporation

Accuflow SP-550 and IBP-550 Syringe Pump

supply, while the Accuflow IBP-550 includes an integrated battery pack for portable and patient transfer applications. Both pumps provide higher infusion accuracy combined with easy-to-use, award-winning User Interface.

medical devices technology and product solutions available, accessible and affordable for everyone.”

Additionaly vTitan is also working on the Next Generation Smart Syringe Pumps and Large Volume Pumps for the US and European markets. vTitan wants to revolutionize and make healthcare available, accessible and affordable for everyone.

Vision

TRADE AND TRENDS

OMRON Healthcare India step-up its after sales service expanse 48 pickup centres were set up in addition to seven existing authorised after-sales service centres across tier-I and II cities in India OMRON HEALTHCARE India, the leader in digital blood pressure monitoring segment, announced the opening of 48 pickup centres in addition to seven existing authorised aftersales service centres across tierI and II cities. This strategic move denotes company’s efforts to deepen its reach and connect with the end-customers via strengthening its after sales service infrastructure by introducing unique concepts and adding value to the existing facilities.

OMRON Pickup Centres, unique in the healthcare monitoring segment, present walk-in facilities for customers for all of their repair needs. The centres provide the first-level check of product and allow the customers the convenience to get the same picked up after the repair at the nearest service centre thus saving them the hassles of visiting the pharmacies or re-

tailers (from which they had bought the products) and a centralised interface for speedy resolution of their service needs.

OMRON service centres provide a window to take care of all

kinds of customer service issues ranging from re-calibration facilities for BP monitors to in and out-of-warranty product repair services needing advanced technical interventions. The customers are also attended and in-

ducted by team of experts who resolve their queries and give them complete know-how on the utility of OMRON healthcare products. These centres are located at New Delhi, Gurgaon, Mumbai, Bengaluru, Cochin,

Chennai, and Kolkata.

Commenting on the initiative, Kazunori Tokura, Managing Director, OMRON Healthcare India, said, “OMRON aims to add on value to the whole customer journey by bringing not only the products but also the services closer to them. Aftersales-service, generally, is the last segment in the journey however it plays a very important role in enhancing the satisfaction- level which is a crucial deciding component in the healthcare segment.”

“Preventive healthcare is all set to play a larger role in contributing positively towards the well being of the people of India and this initiative will help us, further, in making a stronger contribution towards the same as a leading player in the healthcare monitoring segment. The expansion is already on and we will have more centers added to the network soon,” he added.

Hindustan Syringes & Medical Devices, Niraj Industries, receive MDSAP certification Becomes the first set of Indian Manufacturers of Disposable Medical Devices to achieve MDSAP certification THE GROUP companies of Hindustan Medical Devices- Hindustan Syringes & Medical Devices, one of the largest manufacturers of disposable syringes in the world and the largest for auto disable syringes and a strong advocate for Make in India for medical devices and Niraj Industries were among the first set of Indian manufacturers of Disposable Medical Devices to be awarded the prestigious MDSAP quality assurance certificate.

The Medical Device Single Audit Program (MDSAP) allows a single regulatory audit of a medical device manufacturer's Quality Management System (QMS) which satisfies the requirements of multiple regulatory jurisdictions to address patient safety concerns.

Manufacturers can be audited once for compliance with the standard and regulatory requirements of up to five different medical device markets: Australia, Brazil, Canada,

Japan and the US. For manufacturers, MDSAP is of benefit as it reduces the overall number of audits or inspections and optimises the time and resources expended on audit activities. MDSAP certificate aims to promote globally a greater alignment of regulatory approaches and technical requirements which are based on international standards and best practices. Additionally, it also promotes consistency, predictability and transparency of

regulatory programmes.

“We are delighted to have received this Regulatory Quality Assurance Certificate. It aligns well with our goals as we needed this certification to continue exporting our blades and Syringes to Canada which is mandating this certification from all overseas suppliers to Canada from 2019. This certification will moreover allow waiver of US FDA inspections and also from regulatory bodies of Brazil, Japan and Australia which eases our regu-

latory compliance demonstration burden of undergoing multiple audits every year from these countries,” said Rajiv Nath, Jt Managing Director, Hindustan Syringes & Medical Devices.

“MDSAP certificate is an addition to ICMED (Indian Certification for Medical Devices) HMD received from QCI (Quality Council of India). ICMED Certification process allowed us to build competencies and confidence needed to strive for MDSAP,” explained Nath.

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Oxair targets Indian market with new manufacturing facility The company’s Indian manufacturing plant is already working on a new medical oxygen Pressure Swing Adsorption system for a hospital in Delhi and has seen significant interest from other medical facilities in India OXAIR, A leading manufacturer of gas process systems, has launched a new manufacturing facility in India that can help save lives by supplying Australian-standard medical oxygen generators to hospitals on the sub-continent at local prices.

Teaming up with local specialist Agastya Aeroworks, the company from Down Under has made a significant outlay in building and staffing the new factory in Chennai, which it sees as a sound financial investment as it will give Oxair a competitive edge by eliminating import duty in one of the fastest-growing healthcare sectors in the world.

Known as Oxair Gas Systems India, the company’s Indian manufacturing plant is already working on a new medical oxygen Pressure Swing Adsorption (PSA) system for a hospital in Delhi and

has seen significant interest from other medical facilities in India.

India’s hospitals need a reliable source of oxygen to treat an increasing number of people, Oxair’s PSA units can safeguard against events like extreme weather and late deliveries where patients could be vulnerable to failing supplies.

Equipment manufactured at the plant will also help the country’s vast number of hospitals meet new regulatory requirements, that require every hospital to have an alternative supply of oxygen to help prevent the tragedies that have occurred recently where people have died on wards due to a lack of the life-saving gas.

To cope with expected de-

mand, when working at full capacity, Oxair’s factory in Chennai will be able to supply 10 medical oxygen generators per month for customers, who will also be offered finance options to help spread the cost. A medical oxygen generator can pay for itself within three years and has a life expectancy of at least 20 years.

Instead of the removal and reliance of transporting in and handling of dangerous conventional cylinders, except as a back-up supply, India’s hospitals will have the opportunity to be self-sufficient in oxygen by accessing a more robust, reliable and economical means of providing the life-saving treatment to their patients.

James Newell, CEO, Oxair said, “We are delighted to announce that our new factory in India is up and running and is set to play an integral part in our future growth plans. Hav-

ing a manufacturing base on the doorstep of the sub-continent gives us a huge competitive advantage in a massive market, while helping hospitals to deliver improved healthcare for patients in the country.”

Oxair’s generating system delivers constant oxygen of 9495 per cent purity through PSA filtration, a unique process that separates oxygen from compressed air. The gas is then conditioned and filtered before being stored in a buffer tank to be piped directly into to the hospital on demand.

Registered medical devices under ISO 13485, Oxair’s PSAs are fully compliant for use in all hospitals and healthcare facilities. Patients’ lives are dependent on safe and consistent delivery of the highest quality oxygen – hospitals in India can now find a cost-effective and independent solution for producing this life-saving gas.

IBSC forges global partnership with AAMI Biomedical professionals will be able to gain mutual recognition, as AAMI has certified over 7000 biomedical engineering professionals in more than 100 countries THE INDIAN Bio medical Skill Consortium (IBSC) has signed an MoU with the Association for the Advancement of Medical Instrumentation (AAMI). This paves the way for biomedical professionals to gain mutual recognition, as AAMI has certified over 7000 biomedical engineering professionals in more than 100 countries.

The MoU was signed by Dr Jitendar Sharma, MD and CEO, AMTZ and Dr Brad Schoener Vice President (Innovation) AAMI in the presence of Dr Renu Swaroop, Secretary, Department of Biotechnology, Government of India, Sunita Sanghi, Director General, National Skill Development Agency under the Ministry of Skill Development;

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Shyam Sunder Bang, Chairman National Accreditation Board for Certification Bodies (NABCB)- Quality Council of India (QCI), Rajiv Nath, Forum Coordinator, Association of India Medical Devices Manufacturers (AiMed) and Anil Jauhri, CEO, NABCB. IBSC is a pioneer initiative of Andhra Pradesh MedTech Zone (AMTZ) in collaboration with the NABCB - Quality Council of India (QCI) and Association of Indian Medical Devices Industry (AiMeD) to establish an institutional mechanism for certification and skill development of 2,00,000 biomedical engineers & technicians in the country across hospitals, manufacturing units, sales and& marketing, in-

stallation and servicing units, and R&D laboratories. The assessment can be conducted across the country through pan India assessment centres.

Speaking on the occasion, Dr Swarup applauded the initiative of AMTZ and conveyed all sup-

port for this very encouraging development. Sunita Sanghi, DG, NSDA, felt that such initiative would bolster the growth of professionals in the country and is a right move for encouraging the high-end professionals’ skills and enhancement of safety of

medical products.

Speaking of behalf of the industry, Nath expressed his huge appreciation of the dynamic way AMTZ has taken the matter forward ever since its launch and applauded AAMI for coming forward in forging the partnership.

Dr Brad was excited about the potential of associating the healthcare professionals of India, whose skill levels were considered very high and this association would go a long way in taking the Indian professionals to world healthcare map. Recollecting his experience during the visit to AMTZ, he applauded the humongous and fast work of building of AMTZ as world’s first medical equipment manufacturing eco-system.

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Toll Free: 1800-4252355 | Website: www.bplmedicaltechnologies.com For Enquiries: sales.medical@bpl.in CIN: U33110KA2012PTC067282 © 2018 BPL Medical Technologies Private Limited. All rights reserved. BPL Medical Technologies Private Limited reserves the right to make changes in product features, specifications, aesthetics and/or to discontinue the same at any time without notice or obligation

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