Express Healthcare July, 2014 by Indian Express

VOL.8 NO.7 PAGES 92

Cover story National Health Policy: Looking for the right fix Knowledge Key to conquer cervical cancer Strategy Somaiya Ayurvihar AIO: Cancer care for all

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CONTENTS MARKET Vol 8. No 7, JULY 2014

Chairman of the Board Viveck Goenka

LOKMANYA GROUP OF HOSPITALS LAUNCH ORTHOPAEDIC HOSPITAL IN PUNE

LVPEI AND TECH MAHINDRA FOUNDATION JOIN HANDS FOR COMMUNITY BASED REHABILITATION

MSD INDIA TO LAUNCH UNIVADIS, ONLINE MEDICAL EDUCATION PORTAL

IFC INVESTS $7 BILLION IN NEPHROPLUS

‘OUR FOCUS IS TO REACH UNDERSERVED MARKETS IN TIER II/TIER III CITIES AND LOWINCOME STATES’

CII-EASTERN REGION ORGANISES CONFERENCE ON ‘EVOLVING HEALTHCARE INVESTMENT LANDSCAPE’ IN KOLKATA

GURGAON COMES TOGETHER TO DONATE BLOOD AND SAVE LIVES

CMRI CONDUCTS NEURO INTENSIVE 2014

TRANSASIA SPONSORS ‘A TRIBUTE TO THE POETRY OF GULZAR’ TO HELP THALASSEMIC CHILDREN

Editor Viveka Roychowdhury* Chief of Product Harit Mohanty BUREAUS Mumbai Sachin Jagdale, Usha Sharma, Raelene Kambli, Lakshmipriya Nair, Sanjiv Das Bangalore Assistant Editor Neelam M Kachhap Delhi Shalini Gupta DESIGN National Art Director Bivash Barua Deputy Art Director Surajit Patro Chief Designer Pravin Temble

Cervical cancer is the leading cause of cancer mortality among women in India. It witnesses an alarming 1,30,000 new cases and around 75,000 deaths every year. An analysis on the key to prevent the deadly disease and the reason why so many women continue to die of this preventable cancer | P48

Senior Graphic Designer Rushikesh Konka Artist Vivek Chitrakar Photo Editor Sandeep Patil MARKETING Regional Heads Prabhas Jha - North Dr Raghu Pillai - South Sanghamitra Kumar - East Harit Mohanty - West Marketing Team Kunal Gaurav G.M. Khaja Ali Ambuj Kumar E.Mujahid Yuvaraj Murali Ajanta Sengupta PRODUCTION General Manager B R Tipnis

STRATEGY

SOMAIYA AYURVIHAR- AIO: CANCER CARE FOR ALL

KNOWLEDGE

KEY TO CONQUER CERVICAL CANCER

PARADIGM SHIFT IN SYPHILIS SCREENING: NEED OF THE HOUR

CFEHC LAUNCHES EXECUTIVE PROGRAMME IN HEALTHCARE MANAGEMENT

IT@HEALTHCARE

Manager Bhadresh Valia

HP PLANS EXPANSION OF CLOUD-ENABLED RURAL HEALTHCARE CENTRES

Scheduling & Coordination Rohan Thakkar

P25: EVENT LISTING

CIRCULATION Circulation Team Mohan Varadkar

P41: COVER STORY: INSIGHT

MEDICALLSPECIAL

MEDICALL: THE JOURNEY SO FAR

‘WE HAVE ECG MACHINES WHICH USE AN ANDROID APP TO RECORD, STORE AND MANAGE ECGS’

Action agenda: New Health Policy

Express Healthcare Reg. No. MH/MR/SOUTH-252/2013-15 RNI Regn. No.MAHENG/2007/22045. Printed for the proprietors, The Indian Express Limited by Ms. Vaidehi Thakar at The Indian Express Press, Plot No. EL-208, TTC Industrial Area, Mahape, Navi Mumbai - 400710 and Published from Express Towers, 2nd Floor, Nariman Point, Mumbai - 400021. (Editorial & Administrative Offices: Express Towers, 1st Floor, Nariman Point, Mumbai - 400021) *Responsible for selection of newsunder the PRB Act.Copyright @ 2011 The Indian Express 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.

EDITOR’S NOTE

Can we cure ourselves of corruption?

uddenly, everyone is once again talking about the elephant in the room. David Berger, of Broome Hospital, Australia, who is also a Non-Executive Director of British Medical Journal (BMJ), states the obvious when he concludes that corruption ruins the doctor-patient relationship in India. (BMJ 2014:348:g3169) The issue of corruption in medical colleges keeps making front page/prime time news and then seems to die a silent death. We also read of kickbacks to doctors and hospitals from diagnostic and pharma companies but these too fade out. But the BMJ articles seem to be the prelude to a campaign against 'medicine's dirty open secret'. An editorial authored by Dr Anita Jain, the BMJ's India Editor, along with Samiran Nundy, Dean, Ganga Ram Institute for Postgraduate Medical Education and Research, New Delhi and Kamran Abbasi, BMJ's international editor clearly states that the BMJ plans to launch a campaign against corruption in medicine, beginning with a focus on India. (BMJ 2014:348:g4184) They acknowledge that our country is not alone, but believe that if they can defeat corruption here, it will be possible to tackle it in other countries with similar health ecosystems. Dr Jain refers to the deluge of reactions to the articles, from across the country and overseas as well, saying that they wanted to focus more on the solutions, the next steps required to root out the menace of corruption. The editorial mentions some examples like the “transparency wall” that appeared in villages under the Mahatma Gandhi National Rural Employment Guarantee Act, where communities were empowered to monitor the disbursement of funds under the scheme and prevent malpractice. Another example cited is the Right to Information Act. Following the same logic, can we have a “transparency wall” in hospitals, where employees who do want to do right (and Dr Jain assures me that there are many who have written in) can 'blow the whistle' on the black sheep? Most of the responses commend the authors for taking up the issue but Dr Jain reveals that besides the courageous few who have posted their

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Can we have a “transparencywall” in hospitals where employees who do want to do right (and Dr Jain assures me that there are quite a fewof them who have written in) can 'blowthe whistle' on the black sheep?

responses with their identity, there are quite a few anonymous responses from doctors who are unprepared to “take on the system”. Right now, they are silent bystanders, but there is a growing realisation that by not being part of the solution, they become part of the problem. She hopes that in time, these silent observers will come to see the BMJ's campaign as a platform to rally around. The BMJ hopes that the momentum of these discussions will spur hospital administrators, senior doctors, etc. to discuss these issues, start trying to change practices in their clinics or institutions by framing guidelines or appropriate systems which detect corruption, increase awareness, and build zero tolerance to corruption so that it is understood that action will be taken against such practices. The BMJ also hopes to get responses from hospitals and institutions which may have already put in place anti-corruption practices so that these could be highlighted. Maybe there are solutions outside the healthcare space which could be adapted and implemented. In fact, one of the responses, posted by Luca De Fiore, Italy is about the Illuminiamo la Salute (Illuminate health) Project, which was launched against corruption in the health and social sector in Italy, sustained by citizen associations working for integrity and transparency. Dr Jain indicates that the BMJ is planning to work with individuals, institutions, groups or professional medical societies to use the momentum of generated by these articles to start discussions and see how they may propel this further. Future steps could take the form of an advocacy campaign in partnership with organisations in India. Also on the agenda is more articles along the same theme, to take the discussion forward, focussing on what institutions have done to tackle corruption, either here in India or globally. Its time for the few good men and women in healthcare to stand up and be counted. VIVEKA ROYCHOWDHURY Editor viveka.r@expressindia.com

LETTERS QUOTE UNQUOTE

THE NEXT WAVE Very well captured and written, hopefully this will be the next wave in Indian healthcare. (EH June Cover Story: Investors call in Home Healthcare)

JUNE, 2014

Vishal Bali Co-founder & Chairman, Medwell Ventures

NICE READ Interview with Prof Hans Ringertz was a good read. Dr Sashank Singh Agra

KUDOS Well written article (EH June Cover Story: Investors call in Home Healthcare) Ganesh Krishnan Co-founder and Chairman, Portea Medical

HEAD OFFICE Express Healthcare MUMBAI: Kunal Gaurav The Indian Express Ltd Business Publication Division 2nd Floor, Express Tower, Nariman Point Mumbai- 400 021 Board line: 022- 67440000 Ext. 502 Mobile: +91 9821089213 Email Id: kunal.gaurav@expressindia.com Branch Offices NEW DELHI Ambuj Kumar The Indian Express Ltd Business Publication Division Express Building, 9&10, Bahadur Shah Zafar Marg, New Delhi- 110 002 Board line: 011-23702100 Ext. 668 Mobile: +91 9999070900 Fax: 011-23702141 Email id: ambuj.kumar@expressindia.com CHENNAI Yuvaraj Murali The Indian Express Ltd Business Publication Division

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“It is my firm belief that our focus needs to go beyond health insurance. The way ahead lies in health assurance. We need to focus on preventive health care where public participation has a major role to play.” Narendra Modi Prime Minister of India (At the 32nd annual convention of AAPI held in San Antonio)

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MARKET NEWS

Lokmanya Group of Hospitals launch orthopaedic hospital in Pune This new unit in Pune offers an array of advance services in orthopaedic and joint replacement LOKMANYA GROUP of Hospitals announced the launch of their fourth hospital in Swargate, Pune. They have three more hospitals, one in Chinchwad, Pune; the other in Nigdi, Pune; and the third in Kolhapur. A one-stop outpatient facility offering comprehensive orthocare, Lokmanya Hospital Swargate is coming up in Balgandharva Rangamandir at Mitra Mandal Chowk. Spread over an area of 15,000 sq ft, the 40-bedded, Lokmanya Hospital at Mitra Mandal Chowk will provide treatment for the entire range of orthopaedic and spine disorders through joint replacements, spinal surgery, sports medicine, arthroscopy, advanced physiotherapy, trauma and rehabilitation amongst others. Dr Narendra Vaidya, Chief Executive Medical Director,

From L to R: Dr Husaini Saifuddin, Dr Narendra Vaidya, Lt. Gen (Retd) D B Shekatkar, Tanmay Vaidya, Dr V G Vaidya, Dr Ayushi Shrikhande

LHPL and Chief Joint Replacement & Spine Surgeon, Lokmanya Hospital, said, “The new hospital has been custom created for providing world-class orthopaedic care and rehabili-

tation to the patients. We have put in our best efforts in building this hospital to enhance patient’s quality of life. We also made sure that this new hospital will provide Punekars easier access to spe-

cialised and cost-effective orthopaedic services. We are pleased that we have achieved the milestone of treating one and half lakh patients till today and look forward to benefit and heal more patients to make them lead a good and pain free life.” Lokmanya Hospital, Swargate boasts of advance technology offering Computer Navigated Joint Replacement surgeries. It will also reportedly provide advanced treatments like coblation and laser guided surgery for various spinal problems and backache. It has a dedicated Sports Medicine department which will provide treatment for the emerging and budding sportsmen. Advanced physiotherapy treatments and patients’ rehabilitation services are also available to help trauma patients. EH News Bureau

President calls for a holistic healthcare system IN HIS address to the Parliament, the President of India, Pranab Mukherjee made special mention on the need for a holistic healthcare system that is universally accessible, affordable and effective. To achieve this objective, he said that his government will formulate a New Health Policy and roll out a National Health Assurance Mission. It will promote Yoga and AYUSH. To address the shortfall of healthcare professionals, health education and training will be transformed. AIIMS-like institutes will be established in every state. Acknowledging the link between health and hygiene issues, he announced that a ‘Swachh Bharat Mission’ will be launched across the nation for ensuring hygiene, waste management and sanitation across the nation as a tribute to Mahatma Gandhi on his 150th birth anniversary, to be celebrated in the year 2019. EH News Bureau

EMeRG brings ethnography-backed research reports to India Ethnography-based research has been very well accepted in countries like US ETHNOGRAPHIC MEDICAL Research Group (EMeRG), a medical research company, is creating ethnography backed customer-centric medical technology reports in India and

other emerging markets. The EMeRG ethnographers and analysts observe and communicate with end users first hand and gauge customer focused information to formulate

insights. Elaborating on the need for such research, Founding Director, Krishanu Bhattacharjee said, “To bring relevant technologies and healthcare access to customers

in emerging markets, there is a need to be sensitive to varied cultures, ethnic backgrounds, idiosyncrasies related to the work-flow and unique price points within healthcare

set-ups. Our ethnographers do just that.” Ethnographybased research has been well accepted in US and other developed markets. EH News Bureau

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MARKET

LVPEI and Tech Mahindra Foundation join hands for Community Based Rehabilitation Project aims to provide rehabilitation intervention in areas of health, education, economic independence, social inclusion and independent skill development to people with blindness, low vision and the multi-handicapped THE VISION Rehabilitation Centres of LV Prasad Eye Institute (LVPEI), together with Tech Mahindra Foundation, have announced their new project - community-based rehabilitation (CBR) in the urban slums of Ranga Reddy District, Hyderabad. Indira Munjuluri, VP and Global Head for Retail, CPG, Transportation and Logistics business, Tech Mahindra, inaugurated the project recently. The project aims to provide comprehensive rehabilitation

intervention in areas of health, education, economic independence, social inclusion and independent skill development to people with blindness, low vision and the multi-handicapped. A team of trained community field workers and rehab professionals including special educator, physiotherapist and speech therapist will provide door-to-door intervention to the needy people. The project will reportedly be implemented in the urban slums of Madhapur, Chandanagar, Hafeezpet,

Lingampalli, Kukatpalli and Borabanda areas. VC Kumar, COO, Tech Mahindra Foundation informed, “We are positive that the CBR project will be very successful, given their high levels of commitment, experience and passion in the field of vision rehabilitation. We are glad to be able to contribute our bit to society through this project.” Dr Gullapalli N Rao, Founder and Chair, LVPEI said that through this community

out-reach project Tech Mahindra Foundation and LVPEI are looking forward for long-term commitment to accomplish collaborative projects for the welfare of the society in eye care and rehabilitation. Dr Beula Christy, Head, Dr PRK Prasad Centre for Rehabilitation of the Blind and Visually Impaired, LVPEI, said that through its rehabilitation centres, LVPEI has been rendering services to empower people with low vision and blindness so they be-

come important contributing members of the society. The expected outcome of this project in one year is: ◗ Vision screening for 1,50,000 households through door-todoor survey ◗ Provide rehabilitation intervention to around 800 people with blindness, low vision and additional disabilities ◗ Conduct events on community awareness programmes ◗ Formation of around 16 self-help groups EH News Bureau

Sterling Wockhardt Hospital launches pain relief clinic

ABMH in association with AAI launches free medical emergency room at Pune airport

Aim to help people play an active role in their pain management

New facility to provide free medical services to all passengers at Pune airport

STERLING WOCKHARDT Hospital, Vashi, has launched a pain relief clinic with the aim of helping people to take an active role to manage their pain and to regain control over their life. The team of experts at the pain relief clinic will focus on the diagnosis and the management of the pain. Nishant Jaiswal, Center Head at Sterling Wockhardt Hospital, Vashi said, “We focus on providing clinical services as per specific pain issues/ complaints of the patients. Whether your pain is generating from your lower back and sciatic nerve, fibromyalgia, sports injuries, age related ailments, injuries from auto

ADITYA BIRLA Memorial Hospital (ABMH), Pune, in association with Airport Authority of India (AAI), has launched a medical room at the Pune airport. The new facility will provide free medical services to all the passengers at the Pune airport. A trained doctor and a nurse from the hospital will be available 24x7 at the medical room at Pune airport and will cater to all the basic and primary healthcare need of the passengers by providing free consultation, medication, first aid for any minor injuries. The patients will be stabilised at this airport medical room based

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accidents or cancer. We can provide you with the best possible medical care. Since pain is an individual experience and the severity is unique to the patient, our physicians focus on diagnosing your specific cause for pain. Doing this allows us to provide the most personalised treatments possible to improve your life. With the use of individualised treatment plans offered by our doctors in a variety of specialties, patients are given the help they need to alleviate pain and suffering.” The first consultation at the pain clinic was complimentary until June 30, 2014. EH News Bureau

Aditya Birla Memorial Hospital medical room at Pune airport

on their condition during the crucial hours and then would be shifted to hospital if required. A fully equipped ambulance will be stationed 24 hours at the airport to shift emergency cases to ABMH or the nearest local hospital. "ABMH will also organise periodical awareness sessions

at the airport for passengers to have safe air travel. We will also be educating and training the airport staff about the basic life support (BLS) to handle any medical emergency at the airport,” shared Rekha Dubey, COO, Aditya Birla Memorial Hospital EH News Bureau

MARKET

MSD India to launch Univadis, online medical education portal Announces strategic partnership with The Lancet to bring exclusive contents in the form of articles, news, research papers, medical advancements and educational tools MSD ANNOUNCED the launch of Univadis, MSD's medical education and unbiased health information website in India. The interactive Univadis service will reportedly provide medical resources, powerful tools, and accredited education courses from reputed and independent sources, exclusively for healthcare professionals through www.univadis.in. MSD has strategically collaborated with The Lancet, leading independent general medical journal, to bring exclusive content in the form of articles, news, research papers, medical advancements, videos, and educational tools. Univadis, online resource for healthcare professionals, launched in more than 40 countries, is available in 17

languages with more than 20 million registered users worldwide. Univadis is free for healthcare professionals and contains no product advertising. Univadis offers information with access to the latest news, conference updates, educational tools and research articles, 3D anatomy applications with 19 interactive layers, the Merck Manual, over 3000 medical images, and a video library to meet the needs of the healthcare professionals to help them stay up-to-date from leading medical publishers. KG Ananthakrishnan, MD, MSD India said, “We are proud to launch Univadis in India, a unique online medical education service from MSD to aid comprehensive healthcare

Univadis, launched in more than 40 countries, is available in 17 languages management, thereby making available unbiased, reliable scientific medical information across all parts of the country. Univadis portal provides high quality online education enabling healthcare practitioners to expand their knowledge and expertise and thereby offer better quality of care to their patients. MSD is known to be a

trusted partner for continuous medical education across the globe and in India.” Dr Sanjeev Mehta, Consultant Chest Physician, Lilavati Hospital Mumbai said, “Univadis is an important initiative as healthcare professionals need to keep themselves updated on the latest findings in the medical field. The website can be customised according to the interest and speciality of individuals making it easy to search for relevant information.” Dr Achal Gulati, DirectorProfessor of ENT at the Maulana Azad Medical College, New Delhi added, “The Univadis website addresses needs of not only healthcare professionals but medical students as well. The access to hundreds of

high-quality online accredited education courses would greatly help students as it is very important for them to acquire latest knowledge and stay updated.” Dr David Collingridge, Publishing Director for The Lancet’s speciality journals said, “Our partnership with Univadis offers a unique opportunity to increase delivery of the best science to Indian doctors in a free and easily accessible format, which will help promote best clinical practice and health systems reform.” Customers can adapt the website to their own professional needs through an applicative interface, which is also available on mobile, tablet and iPad. EH News Bureau

Evolution of advanced wound clinics in India ConvaTec’s advanced wound care clinic in Bengaluru reportedly has state-of-the-art technologies essential for prevention and healing of chronic foot ulcers CONVATEC HAS announced the launch of ‘Advanced Wound Clinic and Limb Salvage Centre’ in association with M.S. Ramaiah Memorial Hospital at MSR Nagar, Bengaluru. The clinic reportedly has state-of-art technologies essential for prevention and healing of chronic foot ulcers and is aimed at maintaining higher limb salvage rate comparable to the leading centres in the world, with facilities for assessing peripheral circulation and predicting wound healing. While inaugurating the wound clinic, Naresh Shetty, President of M.S. Ramaiah

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L-R : Naresh Shetty and Anand Shirur

Memorial Hospital said, “Our initiative with ConvaTec would be one of a kind venture that

would create a speciality clinic focusing on wound management in the country.”

Anand Shirur, MD, ConvaTec India & China said, “Through the ‘Advanced

Wound Clinic’ we aim to bring the best facilities and wound management technology to patients. I am quite certain that it would change the way foot ulcers are perceived and treated in India.” Shirur further elaborated, “An upsurge in incidences of limb associated complications necessitates the requirement for wound management and centres. This initiative will enable us to expand footprint for the benefit of the people across the country and fulfill the tenets of care required for foot diseases.” EH News Bureau

MARKET

IFC invests $7 billion in NephroPlus The investment will be used by NephroPlus to expand its network of dialysis centres in India

IFC, A MEMBER of the World Bank Group, has invested $7 million in dialysis provider NephroPlus to expand access to high quality kidney care services in India. The company aims to reach over 8,000 patients and help create 1,000 skilled health services jobs in the next five years. This is IFC's first healthcare venture capital investment in South Asia, and also the first from IFC's $250 million Early Stage Investment Program. The investment will be used by NephroPlus to expand its network of dialysis centres in India. NephroPlus already operates 26 dialysis centres across ten states in India. Besides IFC, existing investor, Bessemer Venture Partners, has invested an additional $3 million in NephroPlus. “IFC is a long-term partner for NephroPlus with significant healthcare expertise and a broad network of healthcare clients across emerging markets,” said Vikram

Besides IFC, existing investor, Bessemer Venture Partners, also has invested an additional $3 million in NephroPlus EXPRESS HEALTHCARE

July 2014

Vuppala, Founder and CEO, NephroPlus. “The investment will enable NephroPlus to leverage IFC’s global healthcare knowledge and industry relationships with a view to expand

NephroPlus’ quality dialysis care model in India.” “Providing high quality dialysis care in a highly underserved market not only improves quality of life for chronic kidney care patients,

but also creates skilled healthcare jobs and boosts growth,” said Pravan Malhotra, Venture Capital Lead for South Asia at IFC. “High quality dialysis providers with a commitment to

operational excellence need to scale up to meet India’s enormous healthcare needs. We are helping NephroPlus do that.” EH News Bureau

MARKET I N T E R V I E W

‘Our focus is to reach underserved markets in tier II/tier III cities and low-income states’ Recently, IFC, a member of the World Bank Group, invested $7 million in dialysis provider NephroPlus for expanding access to high quality kidney care services in India. M Neelam Kachhap talks to Christopher M McCahan, Chief Investment Officer for Health & Education, to know more about IFC’s investment in India

Tell us about IFC’s macro view on healthcare in India? Demand for quality private healthcare in India will continue to increase due to demographic and lifestyle factors, rising levels of income, increasing awareness of health issues, limited public sector budgets, and advancement of health technologies. It has been estimated that about $100 billion in investment will be required over the next decade to finance India’s shortfall of over a million beds. India also lags behind several other developed and emerging economies in availability of trained work force (about 50 per cent of the existing medical workforce in India is outside the formal health system) and insurance coverage for healthcare. While there are healthcare delivery systems in the tier I cities that compare favourably with the best institutions around the world this has not percolated to many of the tier II and III cities and rural India where a vast majority of India’s population resides. It is important for the government and the private sector to work together to develop a sustainable healthcare delivery system in tier II and III cities as well as rural India. What specifically is attracting you to the healthcare sector? IFC is a development institution and we view the strengthening of the healthcare system in India critical to its continued development, both in terms of

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alleviating poverty and creating shared prosperity. In India, approximately 60 per cent of healthcare is delivered by the private sector, so it is obviously an important part of the overall system. At the same time, many rural parts of India and smaller cities are under-penetrated and suffer from lack of quality, affordable healthcare services. This makes a strong case for further development of a sustainable and responsible private sector in health to help improve access to healthrelated goods and services to underserved geographies and populations. Where does healthcare stand in your priorities? Providing solutions to expanding quality and affordable healthcare is one of IFC's top strategic priorities. IFC's investment and advisory services businesses are working together with the World Bank to leverage the private sector to increase and improve access by low-income communities to affordable, quality health services, while reducing the burden of high out of pocket health care spending. Our focus is to reach under-served markets, including tier II/tier III cities and low-income states, with an emphasis on Uttar Pradesh. What are the opportunities and challenges for health sector investments in India? While significant capital has been going into the sector in recent years, there is still a sizable shortfall of access to

hybrid models that will, in turn, require investors who have a deep understanding of the drivers and dynamics of the industry. As delivery models become more complex, this will create both challenges and opportunities for healthcare providers, as well as investors.

This is IFC's first healthcare venture capital investment in South Asia

Tell us about your past investments in this sector and your learnings. IFC has been a leading investor in the healthcare sector in India and globally. Compared to other sectors, healthcare is a very long gestation business and requires patient capital. IFC can provide both long-term debt financing and also patient equity capital, and also help to catalyse other longer-term financing options for its clients.

affordable quality healthcare in the country. The private sector needs to continue to play an important role in extending such healthcare to more of the population. There will be increasing collaboration between public and private parties to develop joint solutions and to complement each other in tackling the difficult goal of increasing access to affordable quality healthcare. Both government and the private sector have important roles to play. This will mean more and more public-private partnerships, diversified payment mechanisms, and

Why is the investment in dialysis chain NephroPlus unique for IFC? India remains a highly under-served market for dialysis services. An estimated one million people in India are required to undergo dialysis sessions thrice a week. However, almost nine out of ten people who need dialysis do not have access to it, and it is clinically and financially difficult for hospitals to provide this service. Specialised operators such as NephroPlus help people improve the length and quality of their lives. The company aims to reach over 8,000 patients and help create 1,000 skilled health services jobs in

the next five years, almost a third of these will be for women. IFC's investment in the healthcare sector is India has focused mainly on supporting integrated hospital chains, affordable pharma projects, and diagnostics. NephroPlus is our first specialty care chain investment in the country. The company is focused on treating a single and prevalent disease -- chronic kidney disease -- which afflicts approximately 10 per cent of India’s population. This is IFC's first healthcare venture capital investment in South Asia, and also the first from IFC's $250 million Early Stage Investment Program. The investment will be used by NephroPlus to expand its network of dialysis centers in India. NephroPlus already operates 26 dialysis centres across ten states in India. Besides IFC, existing investor, Bessemer Venture Partners, has invested an additional $3 million in NephroPlus. How does IFC view the need for exits? IFC is a long-term and patient investor. We generally have a longer investment horizon than, for example, private equity investors. IFC takes an exit only after our developmental and commercial roles are fulfilled in a particular project so that we can reinvest our capital to support other impactful projects that require funding. mneelam.kachhap@expressindia.com

MARKET POST EVENTS

CII-Eastern Region organises conference on ‘Evolving Healthcare Investment Landscape’in Kolkata Medical practitioners, fund managers, entrepreneurs and government officials were at the event ‘EVOLVING HEALTHCARE Investment Landscape’ — a conference on ‘Scope of Venture Capital & Private Equity funds, Debt and Angel Funds in Healthcare’ was held in Kolkata recently. Organised by CII – Eastern Region, the conference was attended by medical practitioners, fund managers, entrepreneurs and government officials. The speakers at the event said that the healthcare industry is expected to reach $280 billion by the end of 2020. However, much needs to be done to achieve a faster growth of investments and help the country realise ‘health-for-all’ goal in less than a decade. According to the experts who spoke at the event, the route to faster growth does not lie in conventional sources of investments, but in smart money through venture capital, private equity, debt funds and angel funds. In his inaugural speech, Viresh Oberoi, Chairman, CII Eastern Region and MD of mjunction services said, “India has become a major destination for investment in healthcare, particularly in the fields of pharma, healthcare delivery and medicine. Eastern region is emerging as a potential destination with low costs and quality healthcare. Low cost and quality treatment are its key advantages.” Much of this demand comes from a growing middle-class in big cities. Opportunity lies in investments in high-quality and speciality healthcare services in tier II and III cities where return on investments (RoI) are higher than metros. It is estimated that the healthcare market in tier II and III cities will grow at faster CAGR of 15 to 20 per cent till 2023, five per cent higher than a CAGR of 10 to 15 per cent in

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Sanjay Prasad, Co-Chairman, CII-Healthcare Sub-Committee, Eastern Region, and Executive Director and CEO, Mission of Mercy Hospital & Research Centre, delivered the vote of thanks. The sessions at the event were as follows:

Plenary-I Funding opportunities in healthcare

Inaugural session of the conference

metros. “Most importantly, the IRR of hospitals in tier III is almost double than that of in the tier I cities,” he added. “A large number of patients from Bangladesh, Nepal, Bhutan and Myanmar, visit Kolkata for organ transplant, treatment of orthopaedic, cardiac and oncology problems. There are opportunities in medical tourism as well,” Oberoi said. Funding agencies should view this as a great opportunity to engage, he added. Yet, whether India can become the ‘Utopia’ of healthcare is a question that remains. According to Malay Kumar De, Principal Secretary, Department of Health and Family Welfare, Government of West Bengal, most people in West Bengal have “laid faith in the healthcare facilities offered by the state”. He felt that there was “enough scope for the private sector to come in.” He also chose the conference to disclose that West Bengal will have three medical colleges at Bhangar near Kolkata, Krishnanagar in Nadia and Cooch Behar under PPP model. For the medical college near Kolkata land has been provided with a five-

Audience listening with rapt attention to the experts at the conference

year deadline, while those at Krishnanagar and Cooch Behar will have two years to turn two existing government hospitals into full-fledged medical colleges. He said that the government will soon float e-tenders inviting private players to bid for diagnostic centres to be set up in government hospitals for providing high-end services such as like CT scan, dialysis and MRI. Medical equipment manufacturers can also join the bidding process. “Since West Bengal needs more hospital beds, more doctors, more technicians and healthcare personnel, we need the support of the private sector in a big way,” said De. Suyash Borar, Chairman, CII-Healthcare Subcommittee, Eastern Region and CEO, CMRI

Hospitals said CII will launch a website to connect investors from across the world with entrepreneurs in the Eastern region. A white paper with highlights is being prepared. The objective is to make ‘concerted and focused efforts to make sure big-ticket investments happen in this region and the state.’ Dr Rupali Basu, CEO, Apollo Gleneagles Hospitals, Kolkata and CEO, Eastern Region, Apollo Hospitals Group said, “The year 2103 saw the largest investment made in the healthcare sector in the country. Eastern region, too, got its fair share of the investments. It is our collective responsibility to give greater pace to this trend. We have had enough of plans. Now, it’s time to execute and deliver.”

A viable model always attracts investment. However, factors such as low penetration of insurance in healthcare and bar on FDI in insurance prove to be stumbling blocks for big money to come in. “Private equity and smart money will play a crucial role in healthcare investments in the days to come and will play a key role in bridging its demand-supply gap,” said Dr SP Singh, CEO Healthcare, CK Birla Group. Tapping smart money for investments is not easy but the evolving healthcare sector in India is an attractive destination. Fund managers in India and abroad are looking for ‘good deals’ and ‘viable projects.’ According to Matt Eliot, Principal Investment Officer (Health and Education), South Asia IFC, 31 per cent of its investments happen in India, though mostly in small deals. Opportunities in big ticket deals are likely to rise, he said adding that the new government at the Centre can play a key role. Srini Nagarajan, Regional Director, South Asia, CDC Group, Development Finance Institution, UK Government, said low-cost investments for Eastern region states and for India-Africa chain were being designed. According to him, patience capital pays off in the long run. Investors should add value to their projects to

MARKET attract funds, he said. “Profit sustainability of projects would come from innovation, standardisation and ethical practices,” said Sunil Sachdeva, Co–founder, Medanta – The Medicity. “Though various models were experimented, both capital intensive and those on shoe string budgets, primary care in small towns, technology applications such as mobile medicine could be options for India,” he said. Highlighting the various options available, Gaurav Malhotra, MD & CEO, Bourn Hall International, said much can be achieved if facilities like ‘single window’ clearances can be availed. Key factors such as time bound management and policy stability in government decisions would influence investment mandates.

Plenary - II Integrating finance with healthcare At a clinical exchange of ideas, fund managers crossed thoughts with medical practitioners coming from across the Eastern region. Addressing a key issue of ‘long time taken for funds to be available’, Vrinda Mathur, Director, Grant Thorton India, said, “many promises are made that eventually do not come.” She was discussing on how accessible PE and VC funding are to regional players and felt that entrepreneurs should be clear in addressing issues such as quantum and willingness to disinvest, and clarity of fund requirement and its utilisation, amongst others. Fund managers place promoters at the forefront of discussions, and his impression makes or break a deal. Disclosures build confidence in funding agencies, felt Asish Mohapatra, Director Healthcare Investments, Indian Operations of Matrix Partners, US. Padmaja Ruparel, President, India Angel Network, opined that high network individuals at home and abroad could be tapped for start-ups with a promise. V Kesavan, Group CFO, Narayana Hrudalaya Group, spoke of the various models available and suggested tapping charity money. Dr Sabahat Azim, Founder

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CEO, Glocal Healthcare, pointed out to entrepreneurs timing of projects is crucial for their success. “You should know why and how the money comes for it stores value” — entrepreneurs should build for the future. The session was moderated by Sanjay Prasad, Executive Director and CEO, Mission Mercy

Hospital & Research Centre.

Plenary -III Money for crazy ideas Hari Balasubramanian, Chairman and MD, Ontrack Systems and an angel investor, called for young minds with crazy ideas. “Fund their dreams and you have a project blooming,” he said. Most of the

time finding money for ‘out of the box’ concepts becomes difficult because conventional investors look for comfort in tested projects. An angel investor thus spends a great deal of time explaining concepts to people who may not understand! So, what Balasubramanian does is “structure ideas” that are eventually funded.

According to Samir Agarwal, MD, INDCAP, there is always a ‘right fit for the right idea’ where specialisation is key. He pointed out that there is a great deal of interest in innovative projects in the East and the entire North East. The session was moderated by PL Mehta, Director, Neotia Healthcare Initiative.

MARKET

Gurgaon comes together to donate blood and save lives Professionals and residents were provided easy access venues as a part of the camp ROTARY INTERNATIONAL organised a large-scale blood donation camp sponsored by SABIC, in collaboration with DLF Foundation, on June 13, the eve of World Blood Donor Day. Held at DLF Cyber City, Gurgaon, the camp targeted professionals working in over 350 companies in the vicinity, as well as residents of Gurgaon. Five easy-access venues were set up as part of the camp, including an airconditioned marquee with blood donation beds, and four specially-equipped blood donation vans placed at different locations around DLF Cyber City. Janardhanan Ramanujalu, VP, SABIC South Asia & ANZ said, “True to our spirit of creating the perfect chemistry with our stakeholders, SABIC is committed to support initiatives that create social, economic and environmental values where we operate. This is the second time SABIC in India initiated a blood donation drive in collaboration with Rotary

Camp targeted professionals working in over 350 companies in the vicinity, as well as residents of Gurgaon

International; this time, the event is much larger in scale as we understand that there is a need to improve awareness and accessibility to blood donation in India. We are happy to provide working professionals and residents of Gurgaon the opportunity to donate blood at convenient locations right next to where they work or reside. We are pleased with the response we have received today and hope

more people will come forward to be a part of this noble cause today and beyond.” Vinod Bansal, District Governor, Rotary International District 3010 said, “Every year India requires millions of units of blood, and there is huge shortage. Having sufficient quantities of this valuable resource can save many lives – of road accident victims and trauma patients, patients suffering from dengue, treat

thalassemia, and support patients undergoing major surgeries and complicated pregnancy cases. We are happy to join hands with SABIC and DLF Foundation to make more people aware of how blood donation has a positive impact on improving the overall well-being of Indian society.” Lt. Gen Rajender Singh, CEO, DLF Foundation said, “Healthcare is most important for the poor, and in

this regard, it has been observed that the availability of blood is a crucial factor. DLF Foundation is very happy to support Rotary International and SABIC on this noble cause. This is an opportune time to hold a large blood donation drive because we will soon be going into the dengue season and the requirement of blood and platelets will increase dramatically. We are proud to see that the people of Gurgaon have come in large numbers to support this event, and thank them for their participation. The blood donation camp will create awareness among the employees of Cyber City about the importance and effectiveness of blood donation and I wish the very best for this initiative.” The World Blood Donor Day, sanctioned by World Health Organization, is held every year on June 14 to raise awareness on the need for safe blood and blood products, and to thank blood donors for their voluntary blood donation.

Wockhardt Foundation conducts blood donation drive on World Blood Donor Day Ties up with BSES MG Hospital of the Brahma Kumaris’ for this initiative WOCHARDT FOUNDATION in association with BSES MG Hospital of the Brahma Kumaris’ organised a blood donation camp at Wockhardt Towers, in observance of World Blood Donor Day. Through this joint initiative, 30 per cent of the donated blood will be made available free of cost to people below poverty line. Dr Huzaifa Khorakiwala,

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Dr Hufaiza Khorakiwala with the blood donors at Wockhardt Towers

Trustee and CEO, Wockhardt Foundation said, “Under privileged people cannot afford blood for transfusion in emergency cases. I came across several cases where such people suffered and died because of lack of financial assistance. This World Blood Donor Day, Wockhardt Foundation engaged all employees of the Wockhardt group to donate

their blood towards this noble cause. We thank the BSES MG Hospital for helping us achieve this kind act.” Through this joint initiative, Wockhardt Foundation and BSES MG Hospital made blood available to children suffering from thalassemia, cancer patients, surgeries, accident cases and other medical emergencies.

MARKET

CMRI conducts Neuro Intensive 2014 The two-day programme on continuing medical education in neuro science took place on June 28-29, 2014

CK BIRLA Group’s Calcutta Medical Research Institute (CMRI) organised a two-day continuing medical education (CME) programme called 'Neuro Intensive 2014', which took place in the city on June 28-29, 2014. Neuro Intensive 2014 comprised keynote lectures and symposiums delivered by eminent names such as Prof AK Mahapatra, AIIMS (New Delhi); Prof Dhananjaya Bhat and Dr Radha Krishna from NIMHANS; Prof E Ramakrishnan from Trichy; and Dr GK Prusty of CMRI. The programme was reportedly attended by top medical practitioners from the state of West Bengal. This two-day conference focused on the care of patients with life threatening neurological and neurosurgical illness like head injury, brain stroke, brain haemorrhage, severe epilepsy and paralysis, among others. CMRI claims to be the first hospital in Eastern India to have a dedicated neuro intensive facility. “We at CMRI are bound by the values of CK Birla Group which has continuously raised the standard of medical facilities in the State. This, a first of its kind platform, has some of the revered names in neuro intensive care sharing their experiences and educating medical practitioners across the state on the latest developments in the area,” said Suyash Borar, CEO,

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CMRI Hospital. In his address, Prof GK Prusty, Senior ConsultantNeuro Surgery, CMRI said, “With fast changing lifestyles, acute neurological problems

are encountered. Neurological Intensive Care is one of the newest and fastest-growing specialities in medicine today. The concept of neuro critical care has further

developed to coordinate the management of critically ill neurosurgical and neurological patients within a single specialist unit and to include clinical areas such as acute

ischemic stroke which was not traditionally seen as part of its role. Now, the outcomes for our patients are comparable to any advanced centre in the world.”

CHIMCO BIO-MEDICAL ENGINEERING COMPANY Estd. & Regd. Since 1975

MARKET

Transasia sponsors ‘A tribute to the poetry of Gulzar’ to help thalassemic children Prominent doctors and Transasia invitees from the medical fraternity came in large numbers AS A PART of its corporate social responsibility, Transasia Bio-Medicals sponsored a fund raising musical concert, titled a ‘Tribute to the poetry of Gulzar,’ in aid of thalassemic children. Wellknown as one of India’s finest film makers, lyricist and exemplary poet, Gulzar is known for his romantic and melancholic compositions. Transasia Bio-Medicals has consciously chosen, ‘Making a meaningful contribution to society’ as one of its key and essential goal. Transasia has actively engaged and partnered with several NGOs and has undertaken various initiatives to enhance healthcare and actively promote social

Melodious compositions of Gulzar were meted out by professional singers at the concert

causes in India. Prominent doctors and Transasia invitees from the medical fraternity came in large numbers, showing their zeal and fervour, supporting

the cause of patients suffering from this genetically inherited blood disorder. Held at Kashinath Ghanekar Auditorium, at Hiranandani Meadows, in the city of

Thane, the audience was treated to some beautiful and melodious compositions of Gulzar, which was meted out by professional singers along with their troupe.

Organised by Triumph Foundation, the charitable trust of the Rotary Club of Thane Hills, boasts of a state-of-the-art blood bank and a day-care centre for thalassemic children. The event attracted sponsorships supporting this noble cause and Transasia was the silver sponsor. The proceeds of this programme will be used for free blood transfusions for those who are in need of life-long donations for their survival. The enjoyable night of ghazals and mushairas ended on a melodious note. Transasia ensured that its invitees took back home nostalgia of the yester-years as well as a sense of social responsibility.

EVENT BRIEF AUG - SEPT-2014 1

Medicall 2014

11th Healthcare Executive Management Development Programme

organisations and people to new directions. Participant profile: Those involved in policy formulation, project management, programme development and implementation at hospitals/ medical colleges /healthcare

organisations and responsible for healthcare capacity building, efficiency and excellence in medical service delivery, etc. would be the ideal participants. Intake capacity: 50 participants only Organisers: Department of

Hospital Administration, All India Institute of Medical Sciences (AIIMS) Contact Programme Co-ordinator, HxMDP Room No. 6 A, MS Wing, Department of Hospital

Administration, All India Institute of Medical Sciences (AIIMS) Ansari Nagar, New Delhi - 110029, INDIA. Tel: +91 9013956633, 9968953731, 9582222521 Email: info@hxmdpaiims.com Website: www.hxmdpaiims.com

MEDICALL 2014 Dates: 1-3 August, 2014 Venue: Chennai Trade Center, Chennai, India Summary: Medicall is Indiaâ&#x20AC;&#x2122;s premier B2B medical equipment show and healthcare trade fair and provides a cost effective and accessible opportunity for healthcare entrepreneurs, management professionals and physicians with relevant group of products and services. Contact Sundararajan-Project Director Medexpert Business Consultants Pvt ltd., 7th Floor, 199, Luz Chruch Road, Mylapore, Chennai - 600 004. Tamilnadu, India Phone: 91 44- 24718987 Mob: +91 98403 26020 Email: info@medicall.in

11TH HEALTHCARE EXECUTIVE MANAGEMENT DEVELOPMENT PROGRAMME

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cover )

NATIONAL HEALTH POLICY

LOOKING FOR THE RIGHT FIX

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(

FOCUS:POLICY

Will the government succeed in bringing together the highly fragmented healthcare market with multiple stakeholders, public, private-not-for-profit, private-for-profit firms and corporations to deliver the health expectations of its people? An elite group of industry professionals deliver pragmatic answers to some of today's toughest questions on healthcare delivery BY NEELAM M KACHHAP

here has been a significant focus on the new health policy since President Pranab Mukherjee brought it up while addressing the first joint sitting of Parliament last month. The new National Health Policy is expected to have a better approach to strengthening healthcare system in the country. In the past, ruling governments have struggled to find and establish suitable models for service delivery that could deliver the comprehensive range of services required to achieve the desired health outcomes and to respond to people’s expectations. There is an urgent need to shift healthcare delivery to people-centric primary care. Will the new government find the right fix? Will the government succeed in bringing coherence to the highly fragmented healthcare market with multiple stakeholders, public, private-not-for-profit, private-for-profit firms and corporations? Despite growth in healthcare coverage, infant mortality

in our country is still over 40 per 1000, while maternal mortality is two per 1000 live births. Healthy life expectancy remains about 55 years, compared with close to 70 years reported in countries such as China, the US and Japan. About 40 per cent of all deaths in India are still due to infections and the rest is mainly due to non-communicable diseases. Availability of health care services is quantitatively inadequate. Universal insurance coverage is still elusive although it has attained high degree of social consensus in India. Will the government take note of it? India currently spends about five per cent of its GDP on healthcare. As per WHO's World Health Statistics 2012, almost 60 per cent of total health expenditure in India was paid by the common man from his own pocket in 2009. The new health policy needs to address this. Is it possible to shift away from direct, out-ofpocket payments and move towards financing mechanisms that reduce financial barriers

INDIA’S TOTAL GDP

India currently spends about FIVE PER CENT of its GDP on healthcare

As per WHO's World Health Statistics 2012, almost 60 per cent of total health expenditure in India was paid by the common man from his own pocket in 2009

to care and provide better protection from the financial consequences of ill health? Experts believe that adequate and smart invest-

ment in human resources is the need of the hour to counter outmigration, health worker productivity and enhancing health outcomes. There were about 241 medical professionals – physicians, dentists, nurses, pharmacists and other professionals – per one lakh population of India at the end of the Eleventh Five Year Plan. Will we see a surge in efforts on health workforce planning? Will there be sustainable investment for mobilising and retaining health workers; for health workforce outputs (including outpatient services, safe delivery, immunisations); and for health outcomes? The government needs to implement essential medicines programmes to ensure access of medicines to all. Will harmonising pharma practices gain momentum under the new government? Will the new government promote information exchange and knowledge transfer among various regulatory bodies to improve the quality, efficacy and safety standards of medicines?

Technology is evolving even faster than ever. It continues to drive health system expansion and is transforming the way healthcare is delivered in the primary care setting. Medical devices are making diagnostics better and treatments possible. The government needs to identify the priorities for improving the availability and proper utilisation of medical devices and technology. A logical corollary of developing policy is to ensure that national health policies, strategies and plans have a sound monitoring and evaluation component. The new government needs to strengthen health sector reviews; establishing country health “observatories” or “health intelligence portals”. Will the government invest in institutional capacity to support the regular monitoring and evaluation of problems and progress in their standards of health and health systems? Will the next National Health policy address these challenges? What should be the new national health agenda?

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cover ) The government should focus more on primary and secondary healthcare DR. B S AJAIKUMAR Founder & Chairman HCG Enterprise

Government should stay away from tertiary care and encourage private enterprise to penetrate tier II and III cities through schemes like Arogyasri

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ndia is like multiple countries within a country. We have the affluent India and the middle class India whose numbers are anywhere between 300-350 million people. This population is equivalent to the population of the US alone or Europe alone. This population is educated and highly motivated. They are demanding high-end healthcare equivalent to any advanced country. There is an insurance system which is increasing but still the majority opt to pay in cash. Private healthcare in India covers nearly 70 per cent of the population and majority of the middle class and affluent people get service by private enterprise. It is a very competitive market and in fields such as oncology and cardiology, the private enterprise is able to provide healthcare equal to that of advanced countries, sometimes even better, at a fraction of the cost. India is one of the cheapest healthcare providers in the world, even cheaper than Africa. We are able to provide high-end healthcare at an affordable cost. Today, we are proud to say that India has become a medical destination for foreign patients and this is on the rise. So far the private enterprise has achieved the above with minimal or no government involvement and sometimes in spite of the government. Having said that, we still have a major challenge trying to meet the demands of nearly 900 million people who are less affluent or below the poverty line. The government has made attempts in the past to address this issue but with marginal results.

The social impact has been minimal and needs lot of intervention in various areas. I would like to summarise it as follows: ◗ The government should focus more on primary and secondary healthcare. In some parts of India, infant mortality, maternal mortality, malnutrition, anaemia in women of reproductive age etc are worse than in the Sub-Saharan region. So the focus should be on using our limited funds and human resources to improve the primary healthcare needs of the country. ◗ The government or its related bodies should stay away from tertiary care and encourage private enterprise to penetrate tier II and III cities. This can be done through simple measures like expansion of the Arogyasri

programme which exist in several states. A case in point is how HCG in the last six years has bought about a paradigm shift in cancer care in the country by establishing high-end centres using huband-spoke models, not only in tier-1 cities such as Delhi, Bombay, Bangalore and Chennai, but also in tier II and III cities such as Cuttack, Trichi, Ranchi and Shimoga to name a few. People now do not have to travel long distances and spend money on travel and lodging expenses for several months, they can get high-end therapy near their home. All this has a huge cost saving effect on the family which has not been recognised so far. An organisation like HCG has made this model viable and affordable. It is able to treat even the below poverty line people

with or without the available schemes. Prestiges institutions such as Harvard Business School have appreciated the model and written case studies on them. Why is it that our own government has not recognised and encouraged such models? Their positive social impact is enormous and greatly beneficial to the society. ◗ Based on these models, the government should stop setting up centres such as AIIMS and other tertiary care set ups. Instead, they should encourage private enterprise to perform the same functions at a lower cost and better service. This model will be highly sustainable as compared to the government models that exist today. ◗ In regard to tertiary healthcare, the government should provide subsidy to below poverty people so that they can go to recognised tertiary care centres and get the same care as affluent people get. The motto should be ‘equal care to all, irrespective of their socio-economic status’. The government alone will not be able to delivery such care and only through private enterprise can this be done. ◗ The government should be a monitoring agency making sure that high quality healthcare is delivered and proper outcomes are measured. ◗ I do not believe more money needs to be spent to achieve these goals. Entrepreneurs like us have helped through innovations to bring about these changes. There are large groups of dedicated and highly trained doctors as well as entrepreneurs who are willing to join hands with the government to bring about this change.

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FOCUS: POLICY

Reforms in India’s healthcare cannot happen without reforms in medical education DR GIRDHAR GYANI Director,Association of Healthcare Providers of India

rgent health reforms for the NDA government would be: ◗ Commitment to halve the maternal and infant mortality within five years As you are aware, our IMR and MMR figures are not significantly better than Sub-Saharan African countries. We cannot change the IMR and MMR data without reforms in medical education. We have 50,000 undergraduate seats in various medical colleges and only 12,500 post-graduate seats. US has 20,000 under graduate seats and 32,000 post-graduate seats. Most developed countries have double the number of post-graduation seats to address secondary and tertiary healthcare requirement. With less than 40,000 gynaecologists and 40,000 anaesthetists we can't dream of reducing the MMR. We can use technology to tag every pregnant lady and infant. With remote monitoring using GPs, PG students and ASHA workers we can monitor the progress of every pregnant lady and infant born in this country. ◗ Reforms in medical education If we add 100 new medical colleges every year for the next five years, we will have adequate number of doctors by year 2025. Medical colleges promoted by the private agencies are not going to address the needs of the country due to

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cover ) high cost. Government should convert every district headquarters hospital of North, Central and Eastern India into a medical college. Outstanding doctors across the world generally come from deprived backgrounds. We need to get them to join the medical college. We would like to reiterate that reforms in healthcare in this country cannot happen without reforms in medical education. Courts and Medical Council do not allow a doctor without a postgraduation degree to anaesthetise a patient or perform a caesarean section. With the existing MCI norms, it is very much possible to equalise UG and PG seats in various medical colleges. If this is not addressed, we are not going to have adequate number of anaesthetists to anesthetise a pregnant lady, gynaecologists to do a caesarean section, radiologists to do ultrasound on a pregnant lady and paediatricians to look after the newborns. ◗ CPS-training at all government district headquarters hospitals College of Physicians and Surgeons (CPS), established 105 years ago by the British, offers two year diploma courses in Gynaecology, Anesthesia,Paediatrics and Radiology. Unfortunately, MCI derecognised their courses few years ago. Government health system can have adequate number of broad specialists in vital areas like Anaesthesia, Gynaecology, Paediatrics and Radiology in just two years without any investment by converting all district headquarters hospital as CPS training institutions . ◗ Capping malpractice compensation Medical negligence compensation of Rs 12 crores by the Supreme Court against a hospital in Kolkata drove many patients to consumer courts for a hefty compensation for medical negligence. We will land in a

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We should ensure that medical negligence compensation is capped before legal community understands the financial gains out of medical litigation

situation like in the US within the next one or two years where insurance companies will charge three months of doctor’s salary for covering the losses of malpractice compensation. In the US, to protect the medical profession, no doctor can be sued for more than Rs 1.25 crores. Capping medical negligence compensation is a norm even in many European countries. 84 per cent of Indian hospitals have less than 30 beds in small towns, where more than 50 per cent of our children are born. One stray incidence of medical compensation of Rs one crore will close most of these nursing homes, adding significant pressure on the government health system. Hence, I recommend that we should ensure that medical negligence compensation is capped before legal community understands the financial gains out of medical litigation. ◗ Rationalisation of payment for surgical procedures and treatment by government and private health insurance agencies Today 20 per cent of our country’s population is

getting covered under various health insurance schemes like CGHS, ECHS, ESI, various state schemes as well as the private health insurance programmes. Unfortunately, there is no scientific study performed to find out how much it costs to do these procedures in leading government hospitals as well as private hospitals. We request the government to get one of the reputed consultancy firms to conduct a study and do the costing of major procedures in prestigious government institutions like AIIMS and leading private hospitals which offers quality healthcare and come up with a rational pricing for the procedure. Today, these prices are determined arbitrarily and this is creating major problems across the country because of ill-conceived compensation package which will force the hospitals to cut corners or refuse surgery. A standard rate which gets revised on a yearly basis will be the guideline which will help Central Government as well as various state government schemes and the private insurance companies to work out their own pricing. ◗ Promotion of nursing and paramedical education The nursing profession is gradually dying in India with 50 per cent reduction in admissions, especially in Southern India. This is primarily because the nursing profession does not allow career progression. If that can be facilitated and nurses can become nurse practitioners or nurse intensivists like in the Western countries, then nurses’ work will add value to offer better healthcare services to the patients. Today, there is no body at national level or at state level governing paramedical education. Behind every doctor, there are four technicians. Today their training programme is not governed

by a respectable body. If you can create a State body in every State, it will be like a paramedical university which will set the norms and help in maintaining the standard. Today, most of these paramedical courses are conducted in medical universities dominated by the doctors who, to protect their own interest, do not allow nursing and paramedical professionals to be empowered. ◗ Statutory recognition for National Board of Examination (NBE offering DNB) Today, with over 6000 PG seats, DNB has emerged as an effective option for doctors aspiring to specialise but lack the needed funds. Unfortunately, since last ten years, DNB is under massive attack from MCI to reduce its importance in order to maintain the capitation fees valuation of MD and MS seats. Getting recognition for the National Board as an Act of Parliament will empower DNB to expand aggressively to meet the demand of over two lakh young doctors who are spending two to five years mugging MCQs in Kerala or Kota to get one of those scarce PGseats. ◗ Mobile phone based health insurance Ten years ago, Yeshaswini health scheme was launched in the state of Karnataka by collecting Rs 5/- from 17 lakh farmers. At the end of ten years, over 5.5 lakh farmers had varieties of surgeries and over 50,000 farmers had a heart operation done by paying just Rs 5/- per month. We have 850 million mobile phone subscribers who are spending Rs 150/- per month just to speak on the mobile phone. If we have a regulation asking them to pay Rs 20/- extra with each mobile phone subscription every month, we will be able to offer surgical treatment for 850 million people. China has implemented a similar programme to cover cancer care successfully.

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Government should provide health insurance to all up to one lakh per person DR VIKRAM SINGH RAGHUVANSHI Chief Executive - Healthcare, Jaypee Hospital

itizens and the health sector have huge expectations from the new government. The aim should be to address issues fast and come up with solutions offering maximum benefits. My suggestions are: Addressing communicable diseases: Introduce measures to prevent vector-borne diseases/gastroenteritis, implement TB prevention and eradication and develop prompt and effective treating process. Mass education programme: Health department needs to collaborate with private sector and NGOs to educate the masses. Chronic diseases: First aim is prevention through education, and second is a having a participative approach with all stakeholders. Medical insurance: Government should provide health insurance to all up to one lakh per person. This will resolve 70-80 per cent of all burning health needs of the society. However, the system should be transparent, and easy to avail with stringent monitoring. Tackle corruption: Government facilities to its employees like CGHS/ESI is rotten because of corruption. They need to be eradicated. PPPs: Government also needs to come up with good PPP models. Private sector participation can be ensured only if agreements are unaffected by government change, there is freedom to operate, and the guidelines are . Online monitoring, defined SOPs and quality.

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cover ) Immunisation would go a long way in reducing costs and improving health outcomes DR SUJIT CHATTERJEE Chief Executive Officer, Dr LH Hiranandani Hospital

ven at the start of the century, the quality and outcomes of healthcare in India were significantly lower than most nations of the world. Some progress has been made over the last decade but we still lag behind in some areas. These are fundamentals to the basic health of the nation. It is only a healthy nation that will be able to release its enormous human capital effectively for its betterment. In the metros today, private and public hospitals see cases of rickets which has long been driven down from the more advanced countries in the world. Basic calcium deficiencies need to be altered

alongwith protein and calorie deficiencies. The Government of India has to implement the right delivery mechanism for food to be distributed at the grassroot level, it needs to be stringently monitored and its disruption should be linked to harsh punishment. Utilisation of technology can also create awareness on what common food that is available in the village that may be rich in proteins and minerals that may be eaten to avoid diseases like rickets. Calcium is only one of the areas of deficiency, anaemia is far more common. Thus these common disorders need to be tackled on war footing. It is also necessary to

ensure that basic medicines, including antihelmenthic medications, are available at the primary health centres. While availability is just one part of the problem, educating the masses is another ball game completely. To that end, the Ministry of Health and Information Technology must ensure the use of technology to create programmes that would spread the awareness on basic hygiene – from washing hands prior to eating meals, to understanding the benefits of regular de-worming. Thus, while Government has infrastructure at the rural level it needs to be well utilised so that the vast majority of communicable diseases as well as the issue of

malnutrition is addressed. It is important for the government to also monitor the indiscriminate use of medicines, especially antibiotics, in the metros. Not every fever mandates the use of antibiotics. Also, indiscriminate use of certain types and combinations can only help push the cost of healthcare as newer and resistant bugs are discovered which would respond only to a combination of three or four antibiotics together. It is important that childhood immunisation programmes are implemented very strictly. India has emerged as polio free, if this

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There is a need for wider adoption of efficient modes of healthcare delivery DR BR LAKSHMI Director,Molecular Diagnostics, Counseling,Care & Research Centre (MDCRC)

ealth can never be an isolated topic. It needs to be addressed in a holistic/comprehensive way. The vision should be to ensure a swasthya life for our citizens. We need to have a long vision to achieve this. But, can plan immediate, short term, medium and long term goals to achieve the same. Health is not reactive, it needs a proactive approach. Areas to be looked into are:

Public health ◗ Existing systems and infrastructure

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◗ There exists both central and State government structures. They need to be looked into to have a connect and deliver. ◗ One Public Health Foundation in each state has to link these structures and have accountable deliverables ◗ The rural development and environment ministries, industries and health related departments have to align and contribute to National Health Policy ◗ Research in public health should be encouraged. ◗ The policy should have well thought over systems and

there is a need for wider adoption of efficient modes of healthcare delivery. ◗ Strong drug and vaccine policies should be in place ◗ Bring in incentives for traditional medicines. If this generation loses this valuable, ancient divine science, we will be losing it totally. Good systems in our culture should be preserved and practised. We have to address it through education to reach our long term goals. It should be a part of our public health systems.

Disorders and diseases ◗ We need registries for

common and other disorders to understand the burden and act accordingly. ◗ Priorities can be fixed accordingly and national institutes need to be given accountable deliverables. ◗ Each of the centres in every state will contribute to the understanding and overall measures. ◗ Urban and rural health priorities should be understood well ◗ With regard to neglected or rare disorders a complete plan can be given. We need a well thought out system to identify, prevent and manage the same.

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DR SHANTI PANTVAIDYA Executive Director,SNEHA

Need to adopt gender based violence as a public health concern

he urban health landscape has different priorities and challenges and the launch of the National Urban Health Mission is welcome news. SNEHA works extensively on urban health issues, especially amongst women and children in vulnerable, slum communities of Mumbai. We have gathered, in 15 years, a lot of evidence and real ground information on the issues and challenges in urban slums. We make the following recommendations to the national policy based on our experiences: ◗ Creation of Mahila Arogya Samitis to act as eyes and ears in the community, acting as community mobilisers and for awareness generation. They are effective in facilitating health education with community women and in encouraging them to reach out to more women for spread awareness on maternal health and make women informed and empowered. ◗ Our experience shows that a link worker can be a valuable resource for delivering health messages on antenatal care (ANC), spacing between births and planned parenthood. Link workers (AWWs) can be trained to recognise, refer and help in the management of acute

malnutrition. ◗ Appropriate referral of pregnant women between the various available health tiers (health post, maternity homes, peripheral and tertiary hospitals) can help save lives. This has been demonstrated successfully by our referral system in the Municipal Corporation of Greater Mumbai This can be further augmented by effective use of the government sponsored and supported 108 GPRS enabled emergency ambulance service for quick patient transfer. ◗ Cross-sectoral convergence of the state and government machinery. A well monitored collaboration between the municipal health posts, maternity homes and hospitals and the Integrated Child Development Services (ICDS) can help bring down infant and maternal mortality. ◗ Special attention should be paid to adolescents and youth, especially with respect to anaemia as well as sexual and reproductive health and life. ◗ There is a need for adopting and recognising gender based violence as a public health concern. It will serve to recognise the need for preventive action within the public health education in medical colleges and in the public hospital systems.

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cover ) Government should aim to become a more proactive player in the healthcare sector ZACHARYJONESDirector, Senior Vice President, Portea Medical

The new government should weigh becoming more proactive in ensuring quality standards as well as working to create a larger supply of high quality healthcare workers

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n every major Indian city, corporate hospitals now seem to be on every corner. Modern air conditioned interiors, fancy reception areas, and lounges for foreign patients are a far cry from what the Indian hospital experience was like when the government released its last National Health Policy (2002) more than a decade ago. However, the prevalence of corporate hospitals is not an indication of the success of government intervention in the healthcare sector, but rather a symptom of its failures. Patients gravitate towards branded healthcare establishments because, unlike in the West, patient experience varies drastically based on which healthcare provider they use. In the West, health outcomes are relatively similar if a patient is treated by their local doctor or a premier hospital. India suffers from extremely limited government-mandated quality standards in healthcare and huge variability in the capabilities of accredited individuals and institutions. As the new government considers its next National Health Policy, it should weigh becoming more proactive in ensuring quality standards as well as working to create a larger supply of high quality healthcare workers; if it is able to do this, patient trust in the healthcare system and health outcomes will improve drastically.

Becoming the arbiter of healthcare quality Non-governmental bodies such as the Joint Commission International (JCI) and National Accreditation

Board for Hospitals and Healthcare Providers (NABH) have done important work in establishing standards for healthcare organisations in India. These standards need to become mandatory for all healthcare organisations instead of volition-based; however, the real problem comes in creating and enforcing mandatory quality standards for individual practitioners: this is where the government must step in. The Government of India needs to create a minimum quality standard that all healthcare practitioners in India must meet in order to continue practicing. This requires a three-pronged approach: Re-registration/licensing: The current licensing standards in India need to be revamped. Medical knowledge and standards are changing more rapidly than ever. Clinicians should be required to periodically demonstrate to the government that they are up to date on the latest developments in their field. While some states have elements of an organised re-registration process already in place, a concerted national policy needs to be implemented. Auditing: There is huge variability in the quality of medical practitioners, especially in rural areas where quacks often abound. The government needs to create proactive audit units that spot check clinical skills and prosecute quacks posing as medical professionals. Focus on continuing medical education (CME): CME is currently largely provided by the private sector in India. However, creating standard CME

modules to be completed by all medical practitioners has never been easier. The government should study the models of hugely successful e-learning start ups in the US, such as Coursera and edX, which carry the content of leading global universities and allow students to take classes remotely. The government could easily leverage staff at its premier medical institutes such as AIIMS to teach these classes and make them a mandatory part of the registration process in India, ensuring that all doctors throughout the country have received the same knowledge base.

Improving the supply of healthcare workers Creating quality standards is an important first step in improving health outcomes for the average Indian; however, if there is an insufficient supply of healthcare providers, improving quality will have a relatively limited impact. This is a real challenge in India where there are only six doctors per 10,000 patients; in the developed world this figure is closer to 30. By creating a larger supply of high-quality healthcare workers, individual patients will be able to find credible medical professionals outside of the corporate hospital ecosystem. The Government can do this by granting more degrees, using workers more efficiently and making healthcare a more desirable career path. Creating more supply: The Medical Council of India should be open to creating more seats for doctors and nurses in India as well as make it easier for foreign trained medical workers to

practice in India. The government should work with the Council to help it achieve these goals. Using doctors more efficiently: In the West, nurses (and nurse practitioners) have begun to do much of the work that has traditionally been done by doctors. The Indian government should consider creating the Nurse Practitioner/Physicianâ&#x20AC;&#x2122;s Assistant category in India. At a minimum, the Government should invest in heightening the skill set of Indiaâ&#x20AC;&#x2122;s nurses so that more tasks can be shifted to them, freeing up doctorsâ&#x20AC;&#x2122; time. Creating more attractive career paths: A large number of doctors in India have stopped practising and work in more lucrative (and less stressful) non-clinical roles. Clearer and more lucrative career paths will make healthcare workers more likely to continue practicing. Non-licensed healthcare workers: India needs a large number of paramedical workers including emergency medical technicians, home health aides and ward staff. The government has taken good first steps in this effort with the establishment of the National Skills Development Corporation, however, more concerted work and investment between the government and private sector is needed. In its next National Health Policy document, the government should aim to become a more proactive player in the healthcare sector to prepare the country for a burgeoning population, a rapidly graying population and increasing prevalence of chronic diseases.

cover ) We believe in the need to create a sound clinical research ecosystem SUNEELATHATTE President,ISCR

We need a robust, regulatory framework to ensures that clinical research is conducted in a fair and transparent manner

t is encouraging to note that a new National Health Policy is under consideration, but it is important that this policy focuses as much on unmet medical needs as on preventable diseases. The value and role of clinical research in ensuring better and more effective treatment for several thousands of patients in India is often overlooked. It is only through clinical research that we have found and will be able to find newer and better medicines to treat our population and reduce mortality rates for various diseases, including those unique to our part of the world. The Government of India sponsored Working Group on Disease Burden for the 12th Five Year Plan refers to the ‘triple burden of disease’ that developing countries like ours are facing arising from communicable diseases, emerging non-communicable diseases related to lifestyles

and emerging infectious diseases. In the larger context of India’s unique healthcare requirements and growing incidence of endemic diseases and emerging lifestyle diseases, we need clinical research to develop new and effective medicines and vaccines to tackle our mammoth disease burden and unmet medical needs. India has 16 per cent of the world’s population and 20 per cent of the global disease burden and yet, less than two per cent of global trials take place in India. If we have to find better and more cost effective cures for these diseases in a population that is multi-racial and heterogeneous, it is necessary to conduct clinical research in India. We therefore need a robust, regulatory framework that ensures that clinical research is conducted in a fair and transparent manner, safeguarding the interests of patients while keeping in line

with the basic tenets of science is the need of the hour. The National Health Policy under consideration by the new government must take into consideration the value that clinical research can play in improving the health indices of our country. We also believe in the need to create a sound clinical research ecosystem that encourages local research and innovation. Global trends have highlighted the positive correlation between growth of the clinical research industry and biopharma innovation. A slowdown in the growth of the clinical research industry is detrimental to the culture of biopharma innovation that the government of India is trying to drive and encourage and could represent a lost opportunity for our researchers and scientists. There are several biopharma companies, not for profit organisations, and teaching and medical institutions in the

country interested in doing industry-leading and valuable research for diseases that affect our populations. We need to encourage such innovation and not deter the scientific and medical community from continuing in the quest to find safer and more effective treatment for our disease burden. A focus areas of the new ministry is public health education and awareness. We need to foster an environment where patients participating in clinical research and investigators doing clinical research do not do so in fear of its consequences. Public health education on the value of clinical research and the rights and responsibilities of patients is much needed to address the misinformation and negative perceptions that exist about the clinical research process. The Health Policy must also address the issue of infrastructure and capacity building in the area of clinical research.

Government should increase health expenditure to three per cent of GDP DR ALEXANDER THOMAS Director (CEO) Bangalore Baptist Hospital

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here are a lot of issues that needs focus in the New Health Policy. Some of them are: ◗ Government should increase health expenditure to three per cent of GDP ◗ Strengthen the public healthcare system ◗ Resolve manpower challenges by:

✦ Increasing salary of government doctors serving rural areas ✦ Children of rural doctors should be given priority in school admissions ✦ Special rebates for essential commodities (like army) ✦ Canteen for doctors, like the army canteen ✦ Increase salaries of nurses, especially those serving in rural

areas Other recommendations include: ◗ Upgrading nurses to nurse practitioner ◗ The ratio of undergraduate to post graduate seats should be 1: 1 ◗ Improving infrastructure ◗ Fund allocation to improve the facilities at government hospitals

◗ Strengthen PHCs, taluk and district hospitals ◗ Increase the pool of generalists/family physicians to reduce healthcare costs and increase health efficiency ◗ Increase emphasis on preventive and promotive healthcare ◗ High priority for geriatric care

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Telemedicine needs to be leveraged to its potential to make healthcare more accessible DR ALOK ROY Chairman,Medica Group

A facilitating environment needs to be created to increase the cooperation between healthcare providers from private and public sector

he health sector budget was 1.04 per cent in the 11th Five Year Plan. The expenditure on health should be increased to three per cent of GDP by the end of 12th Five Year Plan (2017) and eventually reach five per cent by 2022, in line with most developed nations. Quality: The quality of Indian healthcare is varied. While one finds availability of adequate quality in major urban areas, occasionally meeting international standards, access to quality medical care is limited or unavailable beyond the cities and in most periurban and rural areas. Substantial budget needs to be allocated to re-engineer government hospitals in terms of infrastructure planning to bring in operational efficiencies and implement appropriate systems and processes to meet minimum accreditation norms for delivering uniform quality

healthcare services Infection control and drug policy: Hospital acquired infections are on the rise across all hospitals in the country more so in the government hospitals where in the absence of adequate quality protocols and infrastructure the same is rampant. Moreover, uncontrolled use of antibiotics in the absence of antibiotic policies at the state and hospital levels is creating a high risk of drug resistance in the larger population. A comprehensive effort at the national level should be carried-out for research studies across the country and come up with adequate measures before it grows out of control. The pharma sector will have to be co-opted in this endeavour. Health financing: The lack of adequately funded public health services forces large numbers of our population to incur heavy out of pocket expenditures even in public

sector hospitals, since lack of medicines means that patients have to buy them. This results in a very high financial burden on families in case of severe illness. The Rashtriya Swasthya Bima Yojana (RSBY) which provides cash less in-patient treatment through an insurance based system up to Rs 30,000 presently is restricted up to secondary care. It should be reformed to enable access to comprehensive primary, secondary and tertiary care. Also effective monitoring mechanism has to be provisioned for the scheme, which has the potential to become a large scam. The scheme, which is presently free of cost, should also explore ways to collect user fees to reduce the scope of fraud and induced demand. Technology: The use of modern technology in healthcare is largely restricted to the private facilities with an exception of certain centres of

excellences in the government system. A dedicated effort needs to be planned and executed to capture maintain and effectively use the resources available in the hospitals through integrated hospital management information systems that are also linked with the public healthcare delivery mechanism at the state and national levels. Tamil Nadu is a good model to learn from. Further telemedicine/ tele-radiology needs to be leveraged to its potential to make healthcare accessible across geographies, especially in the absence of adequate human resources. PPP: A facilitating environment needs to be created to increase the cooperation between healthcare providers from private and public sector. PPPs will have to be envisioned and structured pragmatically with appropriate regulatory framework in place.

Declare evidence building for Ayurveda medical care as national health priority RAJIVVASUDEVAN Founder and Chief Executive Officer,AyurVAID Hospitals

he need for universal health coverage has never been greater. Today, India's healthcare system is grappling with dual burden of accessibility and affordability. It is important for the government to not only implement universal health coverage for emergency medical care but also ensure 'health assurance' by

providing coverage for treatment of chronic and non-communicable diseases as well. The inclusion of India's mother system of medicine, Ayurveda under the ambit of universal health coverage will contribute to this goal substantially since Ayurveda would approach health holistically- diet, lifestyle, medicine, therapies.

Access to Ayurveda care under government universal health programmes should be not restricted to government set-up but also opened up to credible Ayurveda hospitals in the private sector. Ayurveda can play a major preventive, curative, and promotive role in community health- and in women and child heath, in particular. Ayurveda

can be very effective in the management of serious communicable diseases such as chikungunya and dengue, etc. as well. Government should ensure that essential Ayurveda drugs be made available to the masses as prophylaxis and Ayurveda chikitsa (medical management) for con-

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cover ) The government should be the main provider of health care services in the country AMULYA NIDHI Co convenor, Swasthya Adhikar Manchh

ecommendations for the proposed new health policy are: There should be one comprehensive health care policy for the country with the aim of providing affordable, accessible, equitable healthcare. The policy should be pro people in its approach and should cover various aspects of the health system as a whole. For instance, this includes components related to (i) diseases and service delivery (including primary, secondary and tertiary care) (ii) health financing (including insurance), (iii) medical products, drugs and technology, (iv) information, data and research, (v) regulation, governance and stewardship

and (vi) health workforce. People should be at the centre of the health system. While formulating any programmes or policies, instead of being input driven the focus should be on achievement of measurable health outputs, outcomes and impact with clearly defined indicators and mechanisms to measure the same. The government should be the main provider of healthcare services in the country. In terms of its core principles the focus should be on strengthening of the public health care system. This would include, provision of appropriate infrastructure, human resources and financing. The policy should

clearly outline that the government is the main steward of the healthcare system with transparent and accountable systems in place for monitoring. There should be a stringent regulatory framework that clearly outlines the role of the private sector in India and monitors its functioning. The not-forprofit private sector should be encouraged and supported with appropriate policy measures. Ensure that the public health workforce is well motivated and incentivised through provision of financial and non-financial incentives so that talented staff are attracted to work in rural and remote areas through the

public health system. There is a need to focus equally on curative care and emergency services in the country. The district hospital (DH) is a hub of activity in the country. Each district should have a 500-bedded hospital which caters to most of the curative services of the district. The DH should have at least 100 doctors, an administrative structure, and adequate number of nurses, pharmacists, lab technicians and operation theatre assistants. A network of emergency of ambulance services should be provided culminating in district hospitals where

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We need to perform nationwide studies to determine cardiovascular risk factors DR PURSHOTAM LAL Director- Interventional Cardiologyand Chairman, Metro Group of Hospitals

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oronary artery disease (CAD) is affecting individuals in India more than any other country. The disease pattern in Indian patient is different, involving long segments of relatively small arteries making the procedure of revascularisation like stenting, bypass surgery less effective with high incidence of reoccurrence. More and more people, particularly from rural areas, are coming to hospitals with massive heart attacks. Majority of such patients are young smokers and generally itâ&#x20AC;&#x2122;s too late to

do much for these patients. 30 per cent of such patients die within one hour of getting a massive attack and the one who survive remain rather disabled because of poorly functioning pumping chamber in the prime of their life. It seems like that in such a case unless serious steps are taken to prevent this disease, it will be very difficult to handle it by 2020. Unfortunately, there are wide regional variation with coronary artery disease mortality and burden in India. Apart from well known gender-based differences, there are variations in mor-

tality in different states, urban and rural regions and among different socio-economic groups within the states. Although no nationwide study of risk factors exists, review suggests that there are significant state-level and rural-urban differences in major cardiovascular risk factors of smoking, obesity, central obesity, hypertension, hypercholesterolemia and diabetes. However, there is a need to perform nationwide studies for determining cardiovascular risk factors, using uniform protocols to assess regional differences.

There is also a strong need to determine causes of the causes and look into other risk factors besides conventional risk factors like smoking, obesity, central obesity, hypertension, hypercholesterolemia, diabetes etc. Besides initiatives taken by the government, a publicprivate partnership (PPP) between government and private hospitals should play a role in awareness strategies. Also, TV channels can spare some time towards health and promote measures to prevent coronary artery diseases.

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Human resources for health is urgent and ongoing challenge COALITION OF CHRISTIAN HEALTH

There has been a lack of ‘realistic listening’from the key stake holders on the broader factors influencing poor indicators from these districts, and challenges of programme and policy implementation

he National Health Policy should include: Planning: It is a wellknown fact that the macro indicators of health in India has not improved fast enough despite multiple wellmeaning programmes. There are many districts and sub districts where indices are far below acceptable levels and these have not changed over the last few years. There is enough evidence emerging from the various data being captured, where these districts are and what are the indicators. But there has been a lack of ‘realistic listening’ from the key stakeholders on the broader factors influencing poor indicators from these districts, and challenges of programme and policy implementation. There should be a task force, which will identify these priority districts from existing data and come up with system for collecting qualitative data through a process of listening to various stakeholders. The stakeholders should include the state-run systems, the civil society, the NGOs and private healthcare providers. The information emerging out

of these should be used to review the programme and policy being planned and current programmes and policies. Policy and programme implementation: The challenge in programme or policy of India’s healthcare is that though there is flexibility for context variations of the country, this ends at the state level. The various geographical, people group, social, economic and structural in-equities contribute much to poor implementation of programmes and policies. There has to be a way to tackle these in the programme implementation plans suggested to states so that these context challenges are addressed. Both in terms of fund flow and service delivery, there will a need for flexibility and these have to be taken up at district, sub district and taluk levels. Coordination and collaboration: Though there has been much talk on inter ministry coordination and collaboration, it is observed that, intra ministry, there is poor collaboration across various themes. In addition to developing health strategies along with other ministries,

especially those linked to water and sanitation etc., there has to be systems of close coordination, planning and implementation between sub sections of MoHFW. We also have to come together and make plans to address specific diseases challenges in a coordinated way. Public health and primary care focus: It is well known that public health and primary health contributes to the health of a community. There has to be adequate resource allocation, creation of cadres and war foot approach to address the public heath challenges which the country is facing. We have done well in polio, HIV etc. and there are lessons learnt and principles drawn to address the larger public health issues like malnutrition among children, IMR, etc. Similarly, emerging challenges of adolescent health, geriatric health, mental health etc. should be addressed in a proactive way. Human resources: Human resources for health is an urgent and ongoing challenge. In addition to increasing medical, nursing

and allied health training opportunities, there has to be a way in which various alternative healthcare cadres can contribute to service delivery. and help identify as well as build public health programmes. These cadres would include Nurse Practioners, Physician assistants, Technologists, Public Health care Managers etc. Universal health care and right to health:The concepts which are being currently discussed by the government are good and worth revisiting, but it has to be backed by implementation to take care of the complexities in the Indian healthcare system. The three or four stakeholders of healthcare delivery should come together for creating overall healthcare delivery programmes through custom made systems and plans. There should be systems for engaging with different stakeholders like government as the primary responsible holder, corporates, small private providers and the not-forprofit voluntary groups to focus and bring out each sector’s strengths.

more needs to be done in the realm of preventive medicine. Emerging economies such as Brazil and China have far lower infant mortality rate and maternal mortality rate when compared with world average. The government’s first and foremost job is to ensure that India’s infant and

maternal mortality rates are lower than the world’s average. This itself will have a telling effect on human capital. If this is achieved then our huge population can be utilised as the country’s strength. It will enable the country to move ahead in its growth and secure its future.

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Immunisation would go a long way... can be done then there is no reason why other communicable diseases cannot be eradicated. But, it underscores the need for implementation of the comprehensive immunisation programme that the Government already has. Thus while many good programmes have been

launched by the Government of India, its implementation has been exceedingly poor (barring a few examples as one mentioned before). The infrastructure exists but the methodology is still weak and needs to be extensively shored up. Immunisation is important for prevention of

communicable diseases. While it cannot be the panacea for prevention of these diseases it can reduce the severity of the disease and complications which again would go a long way in reducing costs and improving health outcomes. There have been improvements but much

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cover ) Continued from Page 36

Government should increase health expenditure... ◗ Strengthen political will and increase allocation of government resources ◗ Expand geriatrics knowledge base and enhance geriatrics competencies from grassroots to tertiary level ◗ Developing human resources for the healthcare of the elderly should be taken up on war footing. With

immediate effect, every effort should be made to include geriatrics as a separate subject in medical, nursing, social work and psychology curricula. ◗ Creating a pool of health personnel trained in geriatric care at certificate, diploma, undergraduate and postgraduate levels would be

critical to providing geriatric services at the primary, secondary and tertiary healthcare levels. ◗ Awareness creation on elderly on a massive national scale ◗ Reorient healthcare delivery systems to deliver affordable, accessible and elder-sensitive services.

◗ Foster a Public-Private Partnership (PPP) approach to deliver a bouquet of essential and affordable geriatric services ◗ Establish sustainable finance mechanisms to address older adults’ essential medical needs ◗ Developing IT innovations to operationalise elder-friendly

mechanisms ◗ Emphasise on non-communicable diseases ◗ Emphasise on healthcare delivery in slums ◗ Expand palliative care services ◗ Incorporate anaesthesia / radiology training in OG postgraduate curriculum. ◗ Universal health insurance

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Declare evidence building for Ayurveda... firmed cases towards cure and tertiary prevention. It is a known fact that the number of doctors trained in the Ayurveda medical system are more than the number of doctors trained in allopathy medical system in India. There is a need to channelise this resource in a constructive manner. Instead of allowing

BAMS doctors to practice allopathy we should give them support and a better enabling framework to practice authentic Ayurveda. Ayurveda is well positioned to be a strong complementary partner to modern medicine in serving India's health needs. Government should articulate a clear vision and policies for HRD of

Ayurveda doctors and nurses. This is required to attract the best talent to this sector. The government should systematically invest in and promote research of efficacy and safety of Ayurveda products and services and declare evidence building for Ayurveda medical care a national health priority. The Indian Armed

forces should include Ayurveda in their medical coverage for serving and retired personnel and their families. Finally, Ayurveda should be mandated to be covered in the scope of coverage of medical insurance policies in the country, with attendant terms and conditions that are fair and beneficial to all stakeholders- the

patient, insurance company, and the Ayurveda sector. With the above changes, I am optimistic that in the next five years we will see dramatic growth in demand for and supply of Ayurveda products and services enabling Ayurveda to take its rightful position as a mainstream system of medicine in India.

Continued from Page 38

The government should be the main provider... complete care of an emergency patient could be provided. Every fifth district hospital should be developed as a tertiary care (super specialty) hospital to provide advance cardiovascular, neurosurgical or renal dialyses services etc. The focus on urban health, disease prevention, immunisation and providing mother and childcare should be maintained. However, the programme of immunisation should not be expanded disproportionately to include

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diseases like hepatitis, H. Influenza, HPV etc. With the dual burden of communicable and non-communicable diseases and increasing burden of diseases such as cancers, cardiovascular, MDR-TB, accidental road deaths, mental illness there should be provision for prevention and treatment across the country rather than only in urban areas. The cost of care for such diseases is driving several families into debt and poverty, hence there should be a clear plan for

ensuring affordable care to large sections of society. There should be focus on strengthening AYUSH and Indian system should be integral part of the health system and not an afterthought. Creation of health mission in the states has created parallel structures of health delivery, which has weakened the directorates. This should be discontinued and all money should flow to the directorates. But presently the capacity of directorates in extremely poor

to absorb surplus funds. They need to be strengthened further. Post-graduate medical educations seats need to be increased to match with the graduate level admission. The regulatory functions of the health system should be strengthened which include various professional councils (MCI, Pharmacy council, nursing councils), drug regulatory bodies and private sector regulator. Strengthen the domestic pharmaceutical industry and Indian health institutions en-

gaged in research in the public sector. Drug discovery and research should be encouraged for India specific health problems and disease burden. Private insurance sector should not be allowed to enter into public health system. Model of UK instead of US should be emulated. The health policy must be accompanied by a road map or a plan of action that translates the policy into practice with clear outcome and impact indicators and timelines for implementation.

(

FOCUS:POLICY

INSIGHT

Action agenda: New Health Policy

DR ABHAY BANG Director, SEARCH

Dr Abhay Bang, Director, SEARCH, shares his views on what steps need to be implemented as part of the new national health agenda “How far can a mother on foot walk with a sick baby ? Healthcare must be available within that distance.” The First Chinese National Congress on Health

new government brings new hope and possibility of new approaches. The new government led by Prime Minister Modi has included health as the priority and proposed developing a new National Health Policy and National Health Assurance. A window of opportunity has opened for fresh thinking on the challenges and solutions in the health sector. While developing a comprehensive National Health Policy will take time – may be few years, what can be the new National Health Action Agenda ?

The challenge The challenge of providing healthcare to 125 crore people carrying a double burden of disease is a formidable one. In the long history of mankind, germs and diseases have killed more people than the arrows, guns and bombs have. When the stock markets are rising every day to new heights, we must remember that economic growth can not be maintained by sick people. Good health is a precondition for economic growth. We need to protect as well as nurture our human capital to be able to actualise the growth

opportunities. However, good health is not just a precondition for economic growth; rather, it is a goal of economic growth. The increased income must ultimately enhance health, human development and happiness. India faces a double burden of disease. The first burden, the diseases of poverty, includes malnutrition, maternal and child health problems and communicable diseases. The infant mortality rate (IMR) is at 42; nearly 15 lakh children die every year – the most in any single country. More than half of these deaths, total nine lakhs per year, are deaths among neonates – within one month

of birth. Nearly 42 per cent children are malnourished, 55 per cent women are anaemic (NFHS-3), and every year two million new cases of tuberculosis occur. While we continue to face the first burden of diseases, albeit at a reduced level than earlier, India faces another, more difficult burden of non-communicable diseases (NCD) – diabetes, hypertension, stroke, heart disease, cancer, addiction and mental health. The medical science has no vaccine or cure for the NCDs. They are lifelong. It is better to prevent them than struggle to treat millions of incurable patients with enormous medical and social costs.

The choice How should we provide healthcare to people living in nearly one million villages, hamlets, towns and cities? India currently spends about five per cent of its GDP on healthcare, roughly $100 per capita per year at PPP (Shiva Kumar, Lancet, 2010). Only 20 per cent of this care is provided by the public sector (about one per cent of GDP) and nearly 80 per cent by the private sector. Should we go the way of the developed countries a hospital-based, high-cost curative care model? This model costs the European countries 8 to 10 per cent of GDP, or when private

insurance financed, 17 per cent of the GDP in the US. The per capita annual cost of healthcare in the US is $6,000. Worse, if the current trend continues, in the year 2100 the US will need to spend on health care an absurd 97 per cent of GDP! Such healthcare will kill any country. These healthcare models from the West are wasteful, generate perpetual dependence and are impossible to sustain economically. Access to healthcare certainly needs to be assured, but in doing so, generating new disease called ‘unlimited consumption of medical care’ or ‘dependence for health’ should be avoided. Then what is the alternative? The Sanskrit word for being healthy is ‘Swa-stha’, which literally means one who is based in the power of self, is independent. One who is not is called ‘A-swa-stha,’ unhealthy or sick. The concept of health, in India, is inalienably linked with autonomy and freedom. New Health Policy must include the freedom to be healthy as well as the capacity to care for health. This can be better expressed by the term – Aarogya Swaraj. Let me propose a ten point action agenda for the new health minister.

◗ Control the 20 health terrorists The landmark Global Burden of Disease Study (2010) found that the top ten causes

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cover ) of death and life-years lost in India were respiratory infections, three main causes of neonatal deaths i.e. preterm birth, birth asphyxia and sepsis, coronary heart disease, stroke, diarrhoea, tuberculosis and self harm (suicides and injuries). The same study identified high blood pressure, tobacco and alcohol as the top three risk factors causing diseases in the world. The list of top ten risk factors in India includes, in addition – indoor smoke, air pollution, child malnutrition, anaemia, inadequate breast feeding, diabetes and low fruit intake. Healthcare will be needed for several diseases, but control of these ‘20 health terrorists’ – ten diseases and ten risk factors - needs to be the highest national health priority. A national plan of control with time bound goals and targets needs to prepared and pursued relentlessly.

◗ Universal Health Literacy by 2020 Knowledge about health is the greatest protection. Each citizen, especially the women, children and youth should be empowered by making them health literate. Knowledge of health should be an essential content of education at every level. Schools, work places, media, advertisements, distance learning, mobile phones, social media, healthcare movements like yoga – all need to be harnessed creatively to achieve the goal of Universal Health Literacy by 2020.

◗ Freedom from tobacco Tobacco as the major cause of disease, death and healthcare cost is now globally acknowledged. India is no better. A sample survey by SEARCH in Gadchiroli, one of the poorest districts in Maharashtra, revealed that people annually spent Rs 73 crores on tobacco, more than the total annual expenditure by government on health (Rs 10 crore), ICDS (Rs 14 crores) and MNREGA (Rs 22 crores). Following the success of ‘Tobacco-free New York’ several cities in the world are now aiming similarly.

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A national drive to make villages, towns and cities tobacco free will be a highly desirable mission. This will require policy, regulation, enforcement, education, deaddiction and monitoring.

◗ Child-death-free village Nearly 15 lakh child deaths occur each year, mainly in villages and slums, most often without access to healthcare. The global reviews (Lancet 2003, 2005) have concluded that two thirds of these can be averted by ensuring that a selected public health interventions reach all newborns and children. India has its own home grown scientifically proven Home-based newborn and child care (HBNCC) model which is now a part of the National Rural Health Mission (NRHM). It is the most cost effective health care intervention ($7 per life year saved) for child survival. Proper implementation of this package can reduce child mortality by nearly 50 per cent. Moreover, immunisation including newer vaccines, better maternal care, optimum breast feeding and introducing complementary feeding at the age of six months will permit India not only achieve the Millennium Development Goal (MDG) of IMR less than 28 but even exceed. A scheme of awards for making the village or slum child death free for three successive years will be an attractive, awareness raising, popular and achievable goal. That will mobilise communities and the healthcare system to achieve a measurable goal.

◗ Tribal Health Plan Tribal people (10 crores) have the worst socioeconomic as well as health indicators. States with large tribal population, and 150 districts with more than 25 per cent of population being tribal invariably have poor health and healthcare. The promise of the Constitution of India, the sense of justice and the public health considerations all suggest that health of tribal people should

Tobacco as a major cause of disease, death and healthcare cost is now globally acknowledged A national drive to make villages, towns and cities tobacco free will be a highly desirable mission. This will require policy, regulation, enforcement, education, deaddiction and monitoring be specially focussed up on. After failing for 65 years to provide an equitable health care in tribal areas, at last there is an urgent need to develop a Tribal Health Plan in a bottom up manner, to redesign the healthcare delivery system in tribal areas appropriate to the terrain, culture, healthcare needs and availability of human resource. Tribal health will be the ultimate test of the healthcare system in India.

◗ ASHA and ASHOK: Empowered communities Community Health Worker (CHW) is a globally accepted concept. They can make health knowledge and care available in villages and slums, to each home and hut ! India already has deployed 9 lakh female accredited social health activists (ASHAs) in

rural India. Based on the studies done by SEARCH in rural population we estimate that there is a need for 12 hours of daily healthcare work per 1000 population. (HLEG Report, 2011, Planning Commission) Thus at least two CHWs in each village are needed. Addition of a second CHW, preferably a male, to reach out to men, is highly desirable. He may be named ASHOK (free of grief). The ASHAs, and ASHOKs, each one million, to become effective will need several improvements in the step motherly way the ASHA scheme is currently executed. High priority, wider job description, 100 days of training, a functional support structure in the field and more resources with rational incentive structure will make these two million women and men in communities true ASHAs (hope) and ASHOKs. Based on their potential impact on health care to people, ASHA and ASHOK Training Units (AATUs) one per 200,000 population, will be as important as the medical colleges. Healthcare costs – the outof-pocket expenses - cause nearly three to four crore people slip below poverty line annually. A larger number is deprived of the wonderful gifts of medical science due to the economic barriers. The largest financial hardship and deprivation is caused by two component costs – the cost of medicines and the cost of medical emergencies. Two initiatives will largely mitigate this hardship, save lives and reduce suffering.

◗ Medicines for all Since the cost of medicines constitutes nearly half of the out of pocket expenses, and since India has a large drug manufacturing capacity, a goal of making medicines available to the needy is highly feasible. Its essential features will be: ✜ Include only the essential drugs ✜ Rational use of medicines ✜ Use of generic drugs ✜ Procured by the Tamil

Nadu model ✜ Made available through the public healthcare institutions and through ‘Janaushadhalayas’. Researchers have estimated that such scheme, at a cost of about 0.5 per cent GDP, can make ‘Medicines for All’ a reality. This will be a vote catcher, note (money) saver and suffering reducer initiative with a mass appeal.

◗ Healthcare assurance Several countries – Mexico, Brazil, Sri Lanka, China, Thailand have already introduced Universal Health Care partially and incrementally. Principally, India has already accepted the concept in the 12th Five Year Plan. The challenge is how to implement and finance it. Highest level of political will, management skill and the engagement of all stakeholders will be needed. India needs to make the beginning. It is important that it becomes universal, is preventive and primary care oriented, empowers people, and finally becomes a health assurance and not a medical insurance of sky rocketing costs as in the US.

◗ Information and accountability What is monitored gets done. A complete and real time information system reporting the health and healthcare data is essential for programme management. Involvement of communities in planning, monitoring and social auditing will make healthcare system efficient and accountable. Outcome audit and accountability are essential for making the health care a reality.

◗ Public-Private-People Partnership (PPPP) Who will deliver all these ? A policy framework which engages the public, private and the people sector; and a governance culture which permits each sector to play its role will be the only way to meet our original challenge – to provide health and healthcare to 125 crore people or, in other words, the Aarogya Swaraj.

STRATEGY IN FOCUS

SOMAIYAAYURVIHAR AIO: CANCER CARE FOR ALL Samir Somaiya, Chairman, K J Somaiya Medical Trust, along with 40-odd cancer specialists of the Asian Institute of Oncology, came together this March to set up the Somaiya AyurviharAsian Institute of Oncology. Their vision is to provide the best and most comprehensive cancer care, without wavering on the philanthropic values of the Founder. Will they be successful at changing the time-tested definition of a teaching medical college? BY VIVEKA ROYCHOWDHURY

11-year old recalls scenes from the medical camps his grandfather used to organise deep in the tribal areas of the country. He was too young to be of any help except at ferrying medicines from the stores to the various make-shift wards but what stuck with him was the sheer dedication to service. His grandfather, still energetic at 77 years, already managed successful sugar mills but driven by an urge to give back to society, had started a considerable number of philanthropic pursuits in the educational space. The lack of care in the rural hinterland spurred him to add a hospital attached to a medical college as he felt that this would contribute to the cause of increasing access to healthcare facilities by educating more doctors and nurses. More than three decades later, the grandson is laying the ground work to take this vision to the next level. As Chairman and MD of the $250 million Godavari Biorefineries, the

present day avatar of the sugar mills his grandfather set up, Samir Somaiya is also the President of Somaiya Vidyavihar, the umbrella for a plethora

of educational institutions across the country. More importantly, he is Chairman of the Board of Trustees of Somaiya Trust

which was formed in 1959, when his grandfather, who had only studied up to the sixth class, felt that 'vidya dan' (the gift of knowledge) was the best

legacy he could leave and thus started an educational complex, Somaiya Vidyavihar. Today, the Vidyavihar Campus in the Central suburbs of

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STRATEGY

As an institution you can do a few more things than as an individual Dr Ramakant Deshpande Executive Vice Chairman, Somaiya Ayurvihar - AIO and consultant onco surgeon

Entrance to Somaiya Ayurvihar - Asian Insitute of Oncology and waiting area for patients and relatives

Treatment is dependent on the stage of the cancer, not on the patient's paying capacity. Almost 43 per cent of the beds are at a concessional rate Dr Deepak Parikh Prof and Chief, Department of Head and Neck Surgery, and Director, Dept of Laser Surgery, Somaiya Ayurvihar - AIO

We are very satisfied with the response so far and feel that we have already made a mark Dr Jagdeesh Kulkarni Prof of Urology (Oncology) and Robotic Surgery, Dept of Urology, Somaiya Ayurvihar â&#x20AC;&#x201C; AIO

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Mumbai lends its name to the suburb and has come to define the area as a hub for learning and education across multiple streams. Samir Somaiya recalls that his grandfather lived his life by a shlok which translates as: "Neither do I long for Kingdom, nor for heaven, nor do I desire to be free from rebirth, I only wish to remove the sufferings of all beings afflicted by pain."

Laying the foundation So from 1975 to 1981, KJ Somaiya identified the most needy of India, and started with an eye camp, and then moved on to organise multi-speciality health check up camps. Amarkanthak in Madhya Pradesh, Bagidora in Rajasthan, Mesra in Jharkhand in ertswhile Bihar were some destinations where the family patriarch convinced the best doctors of Mumbai to visit and treat a steady stream of patients, sometimes a few thousand people per day, who would flock from the nearby villages to be treated. Samir Somaiya still has vivid memories of those medical camps: living in tents, seeing huge quantities of food being cooked and served to the patients and their attendants,

Samir Somaiya recalls that his grandfather lived his life by a shlok

which translates as: "Neither do I long for Kingdom, nor for heaven, nor do I desire to be free from rebirth, I only wish to remove the sufferings of all beings afflicted by pain" under the supervision of his grandmother. These experiences culminated in the setting up of the KJ Somaiya Medical Trust in 1991. The 22.5 acre Somaiya Ayurvihar Complex, once again in a central suburb (Sion) rather than in the more elite South Mumbai locale chosen by most philanthropic educationalists, was an extension of this same urge to serve, which has persevered down three generations of the Somaiya family. Samir Somaiya as the present day

scion of the family and the Chairman of the Trust, says that the Trust aims to serve the people who are undeserved, who cannot afford to pay. At the same time, the 500bed teaching hospital on the same campus, the KJ Somaiya Hospital and Research Centre, imparts practical training to students and today 23 years later, has grown into a well acknowledged institute in its own right. The old world charm of Somaiya Bhavan, the fulcrum

of the family business in the heart of Mumbai's Fort area seems like another world from the Ayurvihar Campus off the busy Eastern Express Highway but this is where plans are afoot to take the Founder's dream to the next level. But having the vision is one thing; actually investing in it takes commitment and planning. And going by the amounts invested steadily over the last decades, there is no doubting the dedication to the cause. Over the years, the investments have been primarily to build infrastructure and secondly, to fulfill the service mission. Looking ahead, the investment will be to build on four fronts: social, healthcare, teaching and research. The Trust would welcome support from like minded organisations and individuals to support their efforts so that the impact can be multiplied many times over. The effort is to increase community participation so that the Trust's initiatives can become more integrated with and responsive to society.

Fostering disruptive change Looking back over the past

STRATEGY

Karamshi J Somaiya serving food at the Surgana, Nasik Camp in Maharashtra (January 1975)

Sakarben K Somaiya serving food at the Kukma (Kutch) Camp in Gujarat (January 1981)

two decades, Samir Somaiya realised that the best teaching hospitals of the world, like the Memorial Sloan Kettering Cancer Center, New York or the Dana-Farber Cancer Institute in Boston, Massachusetts, are attached to the best centres for tertiary care. In India, this is sadly not so as patients who can pay prefer to avoid the public healthcare system. Any attempt to change this mindset would be akin to turning the existing model on its head but the Somaiya Trust decided to test their hypothesis and fashion a centre which would provide a higher standard of care and service, for all sections of patients, and yet retain their service model and social obligation. A patient who could afford to pay, might get a better room but the standard of care would be the same, across all sections of patients. "We will not waver on the values," emphasises Samir Somaiya. And this was the idea behind the partnership with the Asian Institute of Oncology (AIO), in March this year. Working with a group of topnotch doctors, the Trust decided to create new centre of excellence for cancer care, research and education. Initially carved out from within the existing premises, AIO started operations with 80 in-patient beds but in the next three years, the Trust aims to build a separate complex within the same campus, with over 200 beds in all sub-specialities areas of oncology. This kind of disruptive change takes place incrementally and takes time, especially if it has service as its mission. Samir Somaiya believes institution building takes time but is determined that it can be done.

Building on complementary strengths

Samir Somaiya. Chairman, Board of Trustees, Somaiya Trust

Speaking about the partnership, Dr Ramakant Deshpande, Executive Vice Chairman, AIO, explains how the two entities complement each other. The Trust, which as a philanthropic body runs

almost 34 institutes across the country has an educational spirit whereas the AIO is a professional group of doctors, formed in 2002, comprising more than 40 fully trained cancer specialists, in various speciality areas like paediatric, thoracic, lung, neck, abdominal cancer, urology etc. Most of the members of this group have earned their spurs over the past two-three decades at Tata Memorial Hospital (TMH), which is the country's apex cancer institute. This experience of serving in a public hospital setting, striving to achieve the best results in a resource scarce situation, coping with the sheer volume of patients at hospitals like TMH has honed their skills to an uncommon degree. After having completed 20-25 years of service, when the group left TMH, they formed AIO and started working as a group. Cancer treatment requires comprehensive care across multiple systems as the disease progresses. Thus AIO aimed to provide seamless care to patients. AIO initially was based at the Wellspring Clinic of Piramal Healthcare. Relating the journey, Dr Deshpande says, "We then realised we need a lot more in terms of resources, post operative treatment etc than what was available so we entered into an agreement with Raheja Hospital in 2002. We worked there for a decade but since the ideology of Raheja Hospital was to create a general rather than a specialised hospital, we had to move on. We then entered into an MoU with the Somaiya Group, started working on this project in 2012 and in August 2013, we commenced operations out of Somaiya Ayurvihar." This is the first phase of a 250-bedded standalone comprehensive cancer care hospital, with around 80 beds across all categories, including general wards (called comfort wards), triple, double- and single

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STRATEGY rooms as well as two suites. The Institute offers all specialities like chemotherapy, plastic surgery and reconstruction, etc except radiation therapy. The latter too will be on offer once the second phase takes shape as a standalone complex which will come up on the adjacent one acre plot. The complex will have around 150,000 sq feet, with around 250 beds and is scheduled to take shape in the next 36 months.

Raison d'etre But why did AIO decide to set up another institute for cancer care? Could they have not continued to function out of existing hospitals and lend their expertise to make these even better? As Dr Deshpande reasons, "The increasing incidence of cancer is leading to an increasing number of patients, many of whom cannot afford care. There are not too many institutes across the country that can offer world class care. We would like to take it to the next level. And Somaiya Ayurvihar offers us the framework of a successful institute to set it up so we thought it was a good idea to do good here. Secondly, each of us as individuals, have our own practice and patients, with the revenue flow, reputation, etc but as an institution you can do a few more things than as an individual. For example, clinical research, clinical teaching cannot be really done in the case of an individual practice." Dr Deshpande lists another reason for their choice. If they had continued to work individually, "there would no continuity of experience. For example, a person develops expertise over 20-30 years which does not automatically get transferred to the next generation. But within an institution, an entire generation of individuals can transfer that knowledge to the next generation, and disseminate it across the country further. So we realised that if we want to do that, we need an institution. This is not a nursing home or a private hospital. It is an institution that will focus on research, education and clinical service. All three are equally important. That is

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Main lobby of Somaiya Ayurvihar Hospital

the ethos of this institution." Not yet a year old and the Institute is already getting requests to train hospital staff from other states like Madhya Pradesh as well as neighbouring countries like Nepal. As Dr Deshpande says, this adds to the stature of not just the Institute but also the country because you expose them to an

experience which is at par with the best in the world. Almost echoing the philosophy of K J Somaiya, Dr Deshpande says, "We teach more people, we end up in a better world so it’s better for everybody." Today as treatment evolves to the next level, the team would like to contribute to spreading awareness about

myths associated with cancer. For instance, Dr Deshpande points out that a few decades back, recovery from TB was almost unheard off but today it is a fact. Similarly, hypertension cannot be cured but today there are medicines which help you live with the disease and keep it under control. So the hope is that with cancer too we can hope for the same evolution of treatment. Treatments like aggressive chemotherapy, targeted therapy etc do exist which may not cure but can certainly change cancer into a chronic condition. For the rural population, which makes up 80 per cent of the country, the Institute has educational programmes through various media to educate about cancer, self check ups, etc and cancer detection camps in both rural and urban centres, so that if the detection is early, the prognosis is better. We would like to touch the minds of as many people as possible. The ability to pay is between the patient and the insurer but once we accept the patient, the clinical care is the same, emphasises Dr Deshpande.

ment is dependent on the stage of the cancer, not on the patient's paying capacity. Almost 43 per cent of the beds are at a concessional rate.” Dr Deshpande says, "Apart from this we also have a Foundation called Asian Cancer Foundation which actually helps people who cannot afford to pay anything at all. We do a due diligence and decide on which cases deserve help. Besides this, non-monetary activities are also conducted like rehabilitation of children who have suffered from cancer, awareness camps, as also arranging entertainment for such children, etc.” Following the ethos of spreading knowledge and care, common to both the Somaiya Trust as well as AIO, Dr Parikh indicates the way forward when he says, “We are already looking at tying up with other hospitals. We have colleagues working in various part of the country working in similar set ups so we are trying to coordinate with them in terms of having integrated treatment protocols, etc. We are in talks for tie up with institutes in Patna, Kolkata, Ahmedabad and Bangalore.”

Philosophy of AIO

Waiting area and corridor at Somaiya Ayurvihar-AIO

Echoing Dr Deshpande’s view, his peer Dr Deepak Parikh, Prof and Chief, Department of Head and Neck Surgery, and Director, Dept of Laser Surgery, says, “Treat-

Designed by oncologists The sheer volume of patients has often discouraged doctors from keeping records but Dr Parikh reveals that AIO has developed a complete

STRATEGY

Care with comfort at Somaiya Ayurvihar-AIO

Somaiya Ayurvihar campus has a medical college to complement treatment by education and both clinical as well as translational research

Nursing station

electronic medical records (EMR) system entirely designed and developed by them. This this where the doctors’ decades of experience kicks in because they realised that with oncology, the successful treatment of one episode does not necessarily mean that the chapter is closed. Unfortunately, the same patient will most likely come back with a recurrence. This is where having EMRs will help doctors access past records and shape treatment accordingly. In fact, at AIO, the EMR system is designed to also incorporate the medical history of the family members with the ultimate aim of trying to develop a genetic profiling unique to the Indian sub-continent. This is more true of cancer than other disease conditions as most cancers are known to recur in generations of the same family. Dr Parikh says that they also have a genetic counselling centre for such cases and the ultimate aim

is that once such procedures are standardised, they can percolate the system down to tier II and III cities as well. The other advantage of EMRs is that patients get a password to their files so that they can access them and continue the treatment in their home town, with the treating doctor recording his treatment notes as well. As of today, more than 60 per cent of patients are from out of Mumbai, some from overseas locations like the Middle East, Africa, Bangladesh, etc as well as spanning the length and breadth of the country, this would be a major benefit to patients. There are other in-built add on features as well: alerts on drug-drug interactions, patient sensitivity to certain drugs, as well as smoother and faster check out procedures, thanks to a seamless integration of all billing activities across departments. An additional benefit is that all surgeries are being recorded and archived in a

library, ready for use at the teaching campus, Thus students too can benefit from seeing the skills of the surgeons in action. The main building too will have around 20000 sq ft allocated for teaching and academics. The plan is to have hands-on training workshops, simulations labs etc for the resident doctors, says Dr Parikh. On the research side, once the main building is operational, there are plans for a genetic lab, tissue culture, etc and for this AIO is coordinating with the relevant societies.

A spring board to the future Speaking about the support given by the Somaiya Trust, Dr Parikh mentions how the prohibitive cost of land in Mumbai, makes most such projects unviable because 60 per cent of the project cost would have to be a ‘dead investment’ , i.e. locked up in the cost of the land itself. But in the case of the Somaiya Ayurvihar-AIO proj-

ect, thanks to the support of the Trust, the oncologists did not have to spend on the land they could use the funds to put in place the latest equipment, etc. This has been a big boon and the reason why the project could be started is such a relatively short period of time. After literally hitting the road running, the AIO remains true to its philosophy of giving state-of-the art oncology care at an affordable cost to the needy, as Dr Jagdeesh Kulkarni, Prof of Urology (Oncology) and Robotic Surgery, Dept of Urology, Somaiya Ayurvihar - AIO sums up. The Somaiya Ayurvihar campus offers a medical college so that the treatment is complemented by education and both clinical as well as translational research. The first aspect may be easy to do but for the latter two, it requires a medical college and that is why AIO chose to set up here. As far as treatment model goes, Dr Kulkarni believes that India needs a blend of the

aggressive path that is favoured by US-based oncology centres as well as the more balanced view tended to be taken by the UK and Europe based centres. In the course of their long careers, AIO’s oncologists have trained on both sides of the Atlantic and seem therefore well placed to adopt the best practices of both philosophies. Of course, taking care of the cost factor will be the most important aspect of this hybrid model. Choosing to add capacity phase-wise has proved to be the sustainable way forward, so that recurring costs are met by the current patient loads. As the project successfully scaled up from the initial 40 beds to 80 and now gears up to go to 250 beds in a couple of years, Dr Kulkarni is very satisfied with the response so far and feels that they have already made a mark. KJ Somaiya would no doubt agree and be more than satisfied that his legacy is in safe hands. viveka.r@expressindia.com

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KNOWLEDGE

HPV types 16 and 18 cause 70 per cent of cervical cancers worldwide Dr Partha Basu Head, Dept of Gynecologic Oncology, Officer in Charge, Preventive Oncology Division, CNCI

13 types of HPV are considered ‘highrisk’ and can lead to cervical cancer Dr Mauricio Maza Medical Director, Basic Health International

HPV testing is most effective when used as a screening test on non-symptomatic women Dr Geraldine Roeder Associate Director, Women’s Health Market Development, Qiagen

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ancer mortality is on the rise in India, as in many parts of the world. Prognosis of cancer is still bleak as treatment faces new challenges and long term survival rates do not show very encouraging results. Multifaceted approach to battle cancer is being devised in many countries and prevention is at the centre of all these efforts. Prevention is better than cure. Never has this English proverb been so relevant than in today's cancer burdened environment, especially for cervical cancer as

its etiology is known. “Cervical cancer is the only cancer where we know what is causing the cells to change. We know for certain that human papillomavirus (HPV) causes cervical cancer,” informs Dr Partha Basu, Head, Department of Gynecologic Oncology/Officer in Charge, Preventive Oncology Division, Chittaranjan National Cancer Institute.

HPV connection HPV is a common form of sexually transmitted virus infec-

tion and a large chunk of population gets infected with HPV in their lifetime. Most infections are asymptomatic and so women do not know that they are infected. Some times infections manifest in the form of warts in the genital area. In fact the signs of infection can appear weeks, months, or even years after infection with the virus. What is interesting is that these infections are tackled by individual's immune system much like common cold and get cleared on their own, yet a few persist and lead to cervical cancer.

“Many HPV infections go away on their own. In fact, about 70 per cent to 90 per cent of cases of HPV infection are cleared from the body by the immune system,” says Dr Basu.

Types of HPV HPV infection thus can cause a range of symptoms from warts to cancer. So why do some HPV cause cancer? Dr Mauricio Maza, Medical Director, Basic Health International, an organisation dedicated to reducing the burden of cervical cancer in Latin America

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KNOWLEDGE and the Caribbean explains, “HPV is a group of viruses that includes more than 150 different strains or types. 13 of these types of HPV are considered ‘high-risk’ types and can ultimately lead to cancer of the cervix. In the majority of cases, the immune system overcomes the infection. However, those that are unable to clear the virus and have persistent infection are at the highest risk of developing cervical cancer.” Elaborating further, Dr Basu says, “HPV types 16 and 18 cause 70 per cent of cervical cancers worldwide, while types 6 and 11 are responsible for the majority of genital warts.” These HPV strains can be identified using a DNA test and can be treated accordingly. HPV also infects men though in general, HPV infection does not place a man at a significantly higher risk for health problems. However, HPV prevention is still important for men, as the virus has been linked to uncommon cancers such as penile, anal, and head and neck.

Primary prevention Two vaccines — the bivalent vaccine (Cervarix) and quadrivalent vaccine (GARDASIL) — are mostly used for prevention of HPV infections. These are also available in India, but cervical cancer vaccination has been highly controversial in the country. “The issue related to cervical cancer vaccination are centred around partial efficacy of the vaccine, vaccine safety and of course cost,” says Dr Basu. “A lot of research and finetuning is required to make cervical cancer vaccination effective for the Indian population. In the mean time we need to have other prevention strategies in place to prevent women from developing the disease,” he adds. As the duration of protection of these vaccines is uncertain, even the women who gets vaccinated need screening to monitor the cervix and thus secondary prevention becomes equally important in cervical cancer.

Secondary prevention Screening

for

cervical

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Cervical cancer accounts for 17 per cent of all cancer deaths among women age 30 to 69 cancer is a very important prevention tool. While many researchers are trying to evaluate the accuracy and effectiveness of cervical cancer screening techniques, Pap test and visual inspection of the cervix with acetic acid [VIA] or with Lugol’s iodine [VILI]) are most commonly used in India. These are cost-effective, low in technology and can be performed by trained healthcare workers. Besides these cytology-based tests and DNA testing for HPV is also used, these are more advanced and accurate but expensive techniques.

Growing burden in India In 2008, a quarter of the global incidence and mortality caused by cervical cancer was in India alone. “Cervical cancer is the most common cancer among Indian women above 15 years of age: 38 per cent of cases occur

among women age 15 to 49,” explains Dr Basu. The majority of cases are diagnosed at advanced stages of the disease. Consequently, it is not surprising that cervical cancer is also the leading cause of cancer mortality among women in India, accounting for 17 per cent of all cancer deaths among women age 30 to 69. In 2011, India’s national government launched a programme to address chronic and non-communicable diseases, including screening and treatment of cervical cancer. In parallel, several state governments are pilot-testing alternative non-communicable disease prevention strategies. However, the effect of these well founded programmes is not yet visible. “Much more efforts need to be mobilised for tackling a disease burden of such proportions as cervical cancer. The current efforts are not very focussed,” says Dr Basu.

CPCI project Cervical Cancer Prevention & Control Initiative (CPCI) is a joint collaboration between Chittaranjan National Cancer Institute (CNCI), the Ministry of Health, Government of West Bengal and Qiagen. The objective was to reduce cervical cancer incidence and mortality in rural West Bengal. This was a large-scale commu-

nity-based pilot cervical cancer screening programme using HPV testing for primary screening of women aged 30 or above. Talking about the project Dr Basu informs that 10,000 women were screened from February 2010-March 2011 and 50 cases of high-grade CIN 2/3 pre-cancers were detected of which 45 were treated. In addition, 10 cases of cancer were detected of which eight were treated. Talking about the effectiveness of HPV testing, Dr Geraldine Roeder, Associate Director, Women’s Health Market Development, Qiagen says, “HPV testing can be used in a number of different ways – e.g. for diagnosis of symptomatic women or as a ‘test of cure’ following treatment for cervical pre-cancer. However, it is most effective when used as a screening test on nonsymptomatic women.” But DNA testing is expensive and many people can’t afford it. Nevertheless, Dr Roeder says that when looking at the larger picture this cost is small as compared to the cost of treatment if cervical cancer is not detected early. “If all women are given an HPV test, we can identify women with precancer before their disease progresses too far to treat. This saves lives and also money because the treatment for

pre-cancer is highly effective as well as simple and very cheap compared to the cost of hysterectomy, radical surgeries, chemotherapy and radiotherapy required for advanced cancers,” she explains. “HPV tests like careHPV have been specifically designed and proven in large clinical trials to identify the relevant HPV infections – the ones that could lead to cancer,” she adds.

Conclusion Cervical cancer is preventable. If detected early it can be cured. However, screening and awareness education is the need of the hour to keep mortality rates in check. Research and programmes in India have demonstrated that cervical cancer prevention initiatives have the potential to significantly reduce morbidity and mortality. To date, both research and programme efforts have faced challenges to achieving high levels of screening coverage and adherence to diagnostic and treatment recommendations. Further work is needed to better understand the kinds of messages and communication methods that will promote utilisation of prevention services and the kinds of strategies that may be needed to strengthen referral mechanisms. mneelam.kachhap@expressindia.com

KNOWLEDGE INSIGHT KEJAL MISTRY Product ManagementImmunology, Transasia Bio-Medicals

Paradigm shift in syphilis screening: need of the hour

Accurate and timely detection of syphilis has been a cause of concern for healthcare professionals the world over. Though the non-treponemal method has been the standard method of choice, there is a paradigm shift to the treponemal method offering greater precision. Kejal Mistry, Product Management-Immunology, Transasia Bio-Medicals gives more details

yphilis, once known as the ‘Great Pox’, continues to challenge clinicians with its nuances in diagnosis and management. Serologic tests are the foundation of syphilis management because Treponema pallidum (TP) cannot be cultured in vitro, and knowledge of their diagnostic limitations is critical for clinicians. The mainstay of diagnosis for T. pallidum infections is based on non-treponemal and treponemal serologic tests. Sensitivities of non-treponemal tests vary depending on the type of test and stage of infection, with lower sensitivities in primary syphilis and late syphilis. False-positive test results are associated with viral infections, pregnancy, malignant neoplasms, autoimmune diseases, and advanced age while false negatives are observed due to detection of lipodial antibody detection appearing later during infection. Commercial ELISA tests have been developed since the World Health Organization recommended the use of a combination of a non-treponemal and treponemal test for screening and diagnostic purposes to minimise the risk of syphilis infection through the route of transfusion

Recommendations ◗ Screening should be performed using a highly sensitive and specific test for trepone-

mal antibodies: either TPHA or enzyme immunoassay (ELISA) ◗ In populations where there is a high incidence of syphilis, screening should be performed using a non-treponemal assay: VDRL or RPR. In India, syphilis continues to be a major health problem. However, a constant decline in its prevalence has been observed in recent years. In the current scenario, use of treponemal ELISA has become

the first choice of preference to screen population with early or very late stage of infection in which non-treponemal tests are negatives. This helps in better treatment management and eradicating the incidence either through transmission or transfusion. Since treponemal serology is relatively complex with different profiles seen at different stages of infection and depending on whether treat-

ment has been given or not, detection of total antibodies (IgM, IgG and IgA) helps in screening samples of any type or at any stage of infection. Serum immunoglobulin IgM and IgG antibody responses to T. pallidum have been studied extensively. Anti treponemal IgM antibodies are produced approximately two weeks after exposure, followed by IgG antibodies two weeks after IgM production.

A recent report suggested that new recombinant antigenbased treponemal IgG and IgM ELISAs are the most sensitive, highly specific treponemal tests, and thus suitable for screening. Furthermore, the advantages of the ELISA format include the production of objective results, the ability to link ELISA plate readers directly to laboratory computer systems (reducing the

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KNOWLEDGE ALGORITHM FOR SYPHILIS SCREENING BY TREPONEMAL ELISA potential for errors transcribing results), and the facility for automation.

Algorithm for syphilis screening by Treponemal ELISA The reversal of traditional syphilis algorithms using treponemal ELISAs for screening has led to uncertainty in clinical management. The CDC encourages clinicians to consider treatment for late latent syphilis in individuals with positive treponemal ELISA results to reduce the chance of progression to tertiary complications. Important considerations with the new syphilis tests are their Positive Predictive Value (PPV) and Negative Predictive Value (NPV), which depends on the disease prevalence in the population tested. Highly sensitive treponemal ELISAs will be beneficial for diagnosis of patients with suspected syphilis and with no prior

ELISA

Non Reactive

Reactive

Equivocal Non syphilis or early Syphilis (repeat if suspected)

Equivocal or Reactive RPR test

Repeat EIA

Non Reactive

Reactive

Not Syphilis TP-PA or FTA-ARS test

Non Reactive

Reactive

Not Syphilis

Syphilis

Syphilisperform titer

Late latent or treated? Source: http://www.medscape.com

history, especially in early or late infections with non-reactive, non-treponemal tests. Globally, VDRL and TPHA combination is being increasingly replaced with ELISA tests that detect treponemal

IgG or IgG and IgM. The recent commercial availability of ELISA has made it a method of choice for screening, the world over. (Recently, Transasia has launched ErbaLisa Syphilis for

detection of total antibodies against Treponema pallidum. ErbaLisa Syphilis utilises recombinant antigens of TP which ensures higher diagnostic sensitivity and specificity as compared to non-treponemal tests in

case of primary, tertiary and congenital syphilis. It also minimises the cross reactivity with cardiolipin antibodies. These factors make ErbaLisa Syphilis attractive for laboratories with large workloads.)

HIGHLIGHTS

CFEHC launches executive programme in healthcare management The programme aims to assist enable working professionals in the healthcare industry to develop management competencies and prepare them for leadership roles GREAT LAKES’ Center For Excellence in Health Care (CFEHC) at Great Lakes Institute of Management, a leading B School in India has launched a nine months executive programme in healthcare management - Post Graduate Certificate Program in Health Care Management (PGCP – HCM). The programme has signed a MoU with Hospital Boards of India an affiliate of Indian Medical Association to gather inputs on designing the course structure and strengthening faculty pool.

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The programme has been developed by industry experts within a great academic framework which will help medical experts manage their establishments in a more effective and efficient manner, claims a release from the organisation. Great Lakes’ Center for Excellence in Health Care (CFEHC) has put together an advisory council who will be playing an active role in shaping and refining the programme. Some of the members of the Advisory Council are Dr Devi Shetty–Narayana Heart Center,

Joshua Goh–Avant Health Global, Singapore, Suyash Borar–CEO–CMRI Hospital –Kolkata, Dr M Balasubramanian–IMA President Tamilnadu State 2014 and Dr RV Asokan–Secretary IMA Hospital Board of India. The PGCP–HCM programme is expected to enable working professionals in the healthcare industry to develop management competencies and prepares them to take on leadership roles in their organisations. Prof Bala V Balachandran,

Founder and Dean, Great Lakes Institute of Management said, “The Great Lakes Center for Excellence in Healthcare has been created with the mission of collaborating with the healthcare industry in order to aid the management research on the best practices and industry standards while at the same time building an excellent repository of knowledge for academic and industrial use. Prof S Manivannan, Director, PGCP-HCM, Great Lakes Institute of Management said, “Health care industry is poised

to achieve a phenomenal growth and the major challenge is creating management professionals to support the industry. The Executive Program in Healthcare Management has been designed to train working professionals in healthcare industry in all of functional and managerial aspects of healthcare.” “Through this programme, we shall ensure transfer of evolving industry standards to academic activity and provide framework to development of human resources in the industry,” added Prof Manivannan.

IT@HEALTHCARE HIGHLIGHTS

Inventory management and remote care drive mobile adoption in Indian healthcare: IDC Health Insights More details revealed in the IDC Health Insights report, “Emerging Technology Trends in India Healthcare” ICT SPENDING in the Indian healthcare industry in 2013 is estimated to be $ 413.4 million, a growth of 12.3 per cent over the previous year's estimates, according to IDC Health Insights. More details are revealed in the IDC Health Insights report, “Emerging Technology Trends in India Healthcare” which reveals the evolving business needs, innovative business models and revolutionary technology solutions in the country's healthcare system. Mobility will be the key technology in the Indian healthcare industry, with a high adoption rate of smartphones and tablets. Nearly 29 per cent of the respondents from healthcare provider organisations, in a recently conducted survey indicated that they have some level of clinical mobility in place, while only 7.6 per cent have a mobility solution in place, mostly in the area of inventory management and remote care within the healthcare organisations. "While healthcare IT is at a relatively nascent stage of adoption in India, especially compared to the actual potential, there have been several instances of innovative implementations and best practices in

Mobility will be the key technology in the Indian healthcare industry, with a high adoption rate of smartphones and tablets

India. The growth of the private corporate entities in healthcare has boded well for IT implementation in the industry," says Sash Mukherjee, Research Manager, IDC Health Insights, Asia/Pacific.

"This will also see the rise of other key stakeholders in the industry including the payer community and the life science organisations, when it comes to accountability and care coordination across the care contin-

uum. Technology vendors should partner with healthcare providers and evaluate the key stakeholders especially when it comes to third platform technologies. Given the increase in Line-of-Business participation,

emerging technology vendors need to be aware of the procurement as well as partnership patterns within the Indian healthcare provider organisation," adds Mukherjee. EH News Bureau

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IT@HEALTHCARE

Quest Diagnostics India wins the award for Innovation and Research Recognised by IMA at the Medachievers Award 2014 held in New Delhi QUEST DIAGNOSTICS India won the award for Innovation and Research at the Indian Medical Association (IMA) -Medachievers Award 2014, held in New Delhi. The award was conferred by Dr Harshvardhan, Minister of Health, Govt of India. This award is recognition

of the technological innovations that Quest Diagnostics India has implemented to minimise pre analytical and process errors for enhancing accuracy of testing and provide better diagnostic insights to all its patients. Mukul Bagga, MD, Quest Diagnostics India said, “Quest

The company has implemented various tech innovations to minimise pre analytical and process errors

has always been a forerunner in promoting and stimulating innovative research on a continuous basis. At Quest we have one of the most sophisticated Laboratory Information Management Systems and are particularly proud of being one of the pioneers in the field of digital pathology to benefit cancer patients. These coupled with our patient and physician portal Quest4Health.com empowers us to deliver high quality healthcare outcomes via optimum use of our research and innovation capabilities.” EH News Bureau

HP plans expansion of cloud-enabled rural healthcare centres in India Targets tier II and III cities to set up 20 more eHealth centres TECHNOLOGY AND data solutions provider, HP and Narayana Health have been operating cloud-enabled eHealth centres built in shipping containers and placed conveniently in rural areas of states like Uttar Pradesh. Now HP plans to expand the initiative and set up these eHealth containers in several other remote areas to deliver quality and affordable health-

care. Each container will reportedly be fully equipped with cloud-integrated diagnostics equipment, HP workstations and video conferencing material. HP is targeting tier II and III cities to set up around 20 more eHealth centres over the next 18-20 months in the country to expand this health initiative. EH News Bureau

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EXPRESS HEALTHCARE

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Email your contribution to: viveka.r@expressindia.com Editor, Express Healthcare

MEDICALL SPECIAL IN FOCUS

Medicall: Journey so far Profile of exhibitors

Medicall serves as a great networking platform and brings all medical equipment manufacturers under one roof MEDICALL, INDIA’S largest B2B Medical Exposition, is organised by Medexpert Business Consultants, promoted by Dr Manivannan, Joint Managing Director, Kauvery hospital, a 750-bedded hospital group in South India. Early in his career, Dr Manivannan identified that nursing homes, small clinics and hospitals in tier-II and III cities faced a distinct disadvantage in the market while procuring consumables and equipment for their business. They neither had the choice nor the price advantage enjoyed by the biggies. Talking about the motivation behind starting this show, Dr Manivannan says, “Small and medium-sized hospital owners from tier-II and III cities cannot afford to have qualified purchase managers. Equipment companies also do not have adequate sale force to meet all these hospital owners. Since I have undergone this difficulty for my hospital, I thought Medicall shall bring in all equipment manufacturers under one roof.” Thus Medicall was born. Medicall is a pocket edition of Medica, Düsseldorf. Today, Medicall serves as a platform wherein the equipment companies showcase their products to hospital owners and decision makers. Medicall shows are held in Chennai, Ahmedabad, Kolkata and Colombo.

Medicall: Its rise over the years 2006: The first Medicall exhibition was introduced as a small medical equipment expo and was hosted in Chennai. It was very well received by the

industry and there were more than 100 exhibitors and 3000 visitors. 2007: Medicall 2007 was bigger and better than its first edition. There were more exhibitors and visitors at the event. 2008: The third edition of Medicall attracted 5,400 visitors from across the country. Apart from hospital owners, hospital administrators, and people from other segments like dealers, architects, hospital consultancy, nurses, and biomedical engineers, exhibitors dealing with hospital flooring, lighting, energy saving equipment, storage solutions, ambulance fabricators, etc., also participated for the first time in this show. 2009: With more than 5700 visitors attending Medicall 2009, the expo bridged the gap between the buyers and users and managed to bring them together on one single platform. In this three-day expo, more than 250 exhibitors from all over India and China displayed their latest equipment. Medicall became a pan-India event than just a regional expo in Chennai. 2010: Availability of unique products, choice of products, and international exhibitors were the USPs of Medicall 2010. It was bigger and more incisive in terms of content and participation. International participation increased and over 400 exhibitors from China, Germany, Taiwan, England and India displayed their latest medical equipment. It grew to become India's largest and Asia's third largest medical equipment

Dr Manivannan, Joint Managing Director, Kauvery Hospital

expo. 2011: Around 7500 visitors from India and other countries like Sri Lanka, Nigeria, Nepal, and Taiwan visited the three-day show. The Healthcare Innovation Awards, instituted for first time in this edition of Medicall, attracted several applications from across the country. More than 430 exhibitors from India, Germany, China, Taiwan, Korea, Japan and Iran participated in the show and displayed A-Z requirement of hospitals. 2012: Medicall 2012 was again an year to remember with huge participation from healthcare industry experts and professionals, as well as several new and innovative segments like fashion show on hospital garments and “Hospital Property Mela”. Over 500 companies exhibited at Medicall. It also saw an increase in exhibit

space. Representatives from Germany, China, Taiwan, South Korea, Pakistan and Malaysia participated in Medicall events in that year. 2013: With 530 exhibitors and more than 10500 visitors, Medicall 2013 has grown in terms of quality and quantity. BrainStorm Medicall conferences attracted more than 850 delegates with eight parallel thematic healthcare conferences.

Highlights of 2014 In its 12th edition, Medicall has become a truly international show, with over 500 exhibitors from more than 20 countries and professional visitors exceeding 10,000. The international pavilions will include Baveria, Germany, China, Taiwan, Malaysia, South Korea, Portugal, Italy, the UK, the US, Indonesia and Nigeria.

Surgical products and services facility management, medical disposables radiology /imaging and diagnostics, medical publications, housekeeping solutions, building automation, hospital furniture and furnishings, HVAC and medical gas recycling and hospital waste management, hospital building materials, ambulances consultancy firms, mannequins and teaching equipment, autoclave and sterilizers, regular ICU equipment regular theatre equipment, healthcare design and consultancy, electrical solutions rehabilitation products physiotherapy/orthopaedic technology, energy saving equipment, laundry and kitchen equipment, healthcare IT and software solutions, building automation and facility management laboratory equipment and many more products to meet hospital needs

A premier event Come August, the medical fraternity embarks on its annual pilgrimage to Chennai, reportedly the ‘Mecca’ of the medical legion. It is their perfect getaway to meet one's peers, to compare and choose equipment and best of all to refresh the knowledge base in the intellectually stimulating BrainStorm Medicall. A favourite with many international product companies, Medicall has these come repeatedly to widen their dealer and distributor base. Diversity is a given in this expo. Medicall provides a cost effective and accessible opportunity for healthcare entrepreneurs, management professionals and physicians of India compared to a visit to Dusseldorf or Dubai with a more relevant group of products and services.

Continued on Page 58

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MEDICALL SPECIAL I N T E R V I E W

‘We have ECG machines which use an android app to record, store and manage ECGs’ Gajanan Nagarsekar, MD, Kallows Engineering India speaks to Express Healthcare about the growth of mHealth in India, his company's offerings for the segment and his expectations from Medicall this year How has mHealth evolved in India? Where do we rank in comparison with developed and other developing countries? It is definitely the need of the hour, and India with such a large population, would be able to achieve a significant leap in patient care using mHealth technology. mHealth leverages on the number of mobile phone users – so we definitely have a plus there. I have observed during my visits to various hospitals in the country that there is either a decision pending or work in progress with respect to either having all patient records digitised i.e. on a mobile or tablet based app or work in progress where different modalities such as MRI, CT, cardiac care are being integrated into one application. On the government front there is a lot of room for improvement as the environment and size of health services covered by the government are very diverse and huge. We are just at the beginning phase of mHealth in India. The developed world is advanced in not only implementation but also adoption and training,, we have a lot of room for improvement in both the private and government sectors for the same. Speaking about ECGs, transmission of ECG by the paramedic to the emergency room and getting a response from a doctor is something that is being done since the 90s in the developed world. They also administer drugs for cardiac first aid. At present, the cost of equipment and service is huge in the developed world for treating

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cardiac emergencies. Whereas in India with devices such as ours i.e. mobmon 12.0 we are able to treat a cardiac emergency in seconds and this will help save a lot of lives. But of course, as mentioned above, adoption and training is key to telemedicine’s success in India. The cost at which we will be able to achieve this diagnosis and treatment is going to set an example for the rest of the world. A good example of the same is STEMI India’s programme, presently piloted in Tamil Nadu. Check it out at www.stemiindia.com What are the reigning trends in it? What would be its future? Some common trends in mHealth are adoption of HIS, EMR, EHR and LIMS. HIS – An app that offers information about the patient’s history and the present. This is the superset. EMR – It can cover a single modality or multiple modalities EHR – It would be an EMR with analytics and also integrate data from LIMS and EMR. LIMS – It would be nice if I can receive my pathology i.e. blood sugar test results on my smartphone. Then, I or the doctor could decide whether there is a need to visit a clinic or a hospital. The future is bright for each of these as it would be difficult for a single company to have a domain expertise in all modalities, for example with HIS you will see tie-ups of software and medical device companies working together. Web-based data access is a growing trend and I

We are in the process of setting up dealers and distributors in the country and Medicall is one of the strong platforms to network would like to see it grow with more doctors accepting technology. What are Kallows' offerings for the sector? Kallows is a medical devices company and has ECG machines which use an android app to record, store and manage ECGs. The application on its own can be used to record all patient vitals so it can be extended to record pathology tests results and vitals of the patient, either for the doctor or the patient.

We have different scenarios and delivery channels for the ECG service. To list a few: ◗ Resting ECG: Routine, prescribed or emergency – now one machine like mobmon 12.0 can conduct all these three tasks in a single machine, But the delivery of these three tasks is very different. E.g. Routine ECGs can be conducted by your GP or by diagnostic lab, Prescribed ECGs are mostly done on recommendation by doctors, so they are either at the physician’s or cardiologist’s clinic or hospital and the ECG in a cardiac emergency scenario happens only in the Emergency/ Casualty ward of a hospital. So having a Smartphone capture an ECG and transmit it during routine or emergency is a key step – it is like a car which can be driven and flown if required. ◗ Cardiac monitoring: Post angioplasty or bypass – Patients, mostly aged, require a hand holding in the early days post-surgery. If their ECGs can be reviewed by their cardiologist or physician on a daily or weekly basis it would bring a significant change in the patient’s confidence. It will also add to the convenience of the family members and friends, who would then not only be assured but will applaud the tech. Our mobmon 3.0 product has done patient monitoring during Goa and Mumbai marathons in 2013 and 2014 respectively under supervision from Dr Aashish Contractor, Medical Director for both the marathons. Most of the products on the Internet with respect to this area of patient

care are either 3-lead or single lead ECGs. ◗ Sports monitoring: It is similar to cardiac monitoring but less hand holding is required and the features would include a lot of health and wellness related information and analytics. How are they different from those offered by others in this sphere? Differentiating our products with other ECG companies, we would say Kallows India designs, manufactures and patents all its products. More importantly, features such as Live-Transfer, File-transfer, reporting of ECG on smartphone, 1000+ ECGs recording and storage on a single charge are the biggest differentiators, and even legacy companies do not have such hi-tech features for their ECG machine. Most important is the cost at which it is offered. The fidelity of the ECG is way above expectations while reviewing on the phone or web. What are your expectations from Medicall this year? We are in the process of setting up dealers and distributors in the country and Medicall is one of the strong platforms to network. We aim to create awareness about our hi-tech products which can save lives in seconds. For e.g. live-transfer feature; sending ECGs for reviewing and reporting through smartphones etc. Moreover, they are also priced comparably to the basic ECG machines in the market. lakshmipriya.nair@expressindia.com

MEDICALL 2014 SPECIAL

New age solutions from Prime Medical Systems Offers modular furniture, metal false ceiling and flooring solutions amongst others for healthcare players PRIME MEDICAL Systems specialises in the supply and implementation of clinical interior solutions such as modular furniture for specialised areas like lab, pharmacy, nurse stations, metal ceiling systems, homogeneous vinyl flooring solutions and pneumatic tube systems. Prime represents renowned healthcare furniture manufacturers like Herman Miller, US; Chicago Metallic Corporation; Mannington Commercial; and Hanter IT, Sweden for pneumatic tube systems. Prime has been consulting and creating clinical and administrative applications in healthcare for the last few years. Their staff and designers work with hospital professionals to create an environ-

ment that supports the delivery of quality patient care and function flawlessly. Prime Medical, with support from principals like Herman Miller, takes a research based problem solving approach to the needs of healthcare professionals and the facilities in which they work. The goal is to solve their customers’ problems better than anyone else. Herman Miller’s scope of supply includes furniture for lab, pharmacy, nurse stations, carts and storages, consulting room solutions, administrative work stations and seating solutions. All Herman Miller furniture are made of highly durable impact resistant plastic, powder coated steel structures and are known for its durability. These products go

Prime creates clinical and administrative applications in healthcare since the past few years through rigorous tests, simulating the conditions of a fast paced hospital environment, making sure they will stand upto real-world use. All accessories and components can be removed, making every surface accessible for cleaning. All corners are rounded and a

softer surface material than metal adds up to a user friendly design. All Herman Miller products are warranted for 12 years. Chicago Metallic is known for their metal false ceiling solutions for clinical areas. They offers a comprehensive range, from the most complete programme of lay-in panels to air tight clip-in systems. These systems are ideal for operation theatres, ICUs, wards, corridors, lobbies and other administrative areas. Mannington Commercials, US has the full range of vinyl flooring solutions for the most demanding clinical areas. They are reinforced with aluminium oxide, making it real tough and durable. They have a protective wear layer providing ease in maintenance,

significantly reducing the need for polishing and maintenance. Hanter IT, Sweden manufactures feature rich and durable pneumatic tube systems. Prime Medical Systems has the expertise to provide design, implementation and backup support for their entire range of products and solutions. They have a very impressive list of happy and satisfied customers. They include Kerala Institute of Medical Sciences, Trivandum; Medical Trust Hospital, Cochin; SUT Hospital, Trivandrum; MIOT Hospital, Chennai; Continental hospital, Hyderabad; PGIMS, Rothak; Jayadeva Institute of Cardiology, Bangalore; Shanthi Hospital, Bangalore and many more.

Contact

Draeger Safety India Pte Ltd Draeger Medical India Pte LtdGoldline Business Centre, Link Road Malad 400064 Mumbai, India www.draeger.com

Dräger India extends reach of compact ventilator, Carina An initiative to provide optimum ventilation solution DRÄGER, medical and safety technology provider, extends its reach beyond the metro cities of India with the compact and mobile ventilator, Carina. It comprehensively fits the needs of hospitals in smaller cities and towns in India. It optimises workflow and workspace usage. It offers a range of ventilation modes for spontaneous and mandatory ventilation. Its light weight and compact size brings in mobility within the hospital. Although the healthcare industry in India has shown significant progress over

the last few years, interior towns of Indiacontinue to be deprived of the ventilation technologies optimised for their needs. Carina intends to address the challenges of specialist owned hospitals and facilitate them with quality and economical ventilation. Carina, along with its original accessories such as Novastar and Classicstar masks, provides also high performance non-invasive ventilation, including synchronisations and leakage compensation. It supports spontaneous breathing attempts with the ‘room to

breathe’ concept during all invasive ventilation modes and is easily transported between departments. Further elaborating on this initiative, Nikil Rao, Country Manager, Dräger India, said, “We identified the requirements of our customers in interior towns of India for a multi-purpose and economical ventilation solution. We created an offering of Carina along with its accessories to connect to the needs of our customers.” Dräger Medical GmbH is the manufacturer of Carina.

Milind Deshpande Tel +22 4080 3838 milind.deshpande @draeger.com

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MEDICALL 2014 SPECIAL

LED lighting solutions from Meditech Electronics They offer highly power efficient and reliable rich natural light quality in a significantly cost effective way SINCE THE past few years, as per high market demands, Meditech Electronics is working with an aim to develop an energy efficient, cost effective and environment friendly lighting system which can be used as a suitable substitute for international brands in the healthcare industry. Meditech Electronics’ lighting system boasts of features such as high brightness, high color purity, no radiation, long life-span, and swift reaction. The company has incorporated the latest LED technology to give highly power efficient and reliable rich natural light quality in a significantly cost effective way. Meditech Electronics’ sole objective is to develop an

appropriate import substitute, which is able to address the requirements of private as well as big organisations all over India.

Advantages Meditech’s LED operating light is ideal for modern operation rooms and suitable for all requirements of various operat-

ing conditions because of its following characteristics: Improved work efficiency: Its illumination quality, high shadowless rate and high definition help to improve doctors’ working efficiency Eco-friendly: It has 50 times more lifespan and the system uses less energy in comparison to a halogen lamp. Cool light: LED does not release infrared rays, which produces heat and prevents tissue from drying. It creates a pleasant operating environment for fatigue-free operations in the OT Perfect shadow control: The structure of the lighting system helps the user to precisely control the desired illumination angle and area. Because of

SB NAIN CEO, Meditech Electronics

its unique advantages, now it is being used in many fields. It is the best choice of OT lighting in medical and healthcare set ups. The company’s product range :

LED operating lights ultra series ◗ Model No. ME-301 ◗ Model No. ME-401 ◗ Model No. ME-403 ◗ Model No. ME-404

LED operating lights unique series To fulfill the customers’ requirements, there is a new series with extra high luminance, brightness, high colour purity and no radiation ◗ Model No. ME-601 ◗ Model No. ME-603 ◗ Model No. ME-606

Continued from Page 55

Medicall: Journey so far Medicall’s leadership forum fouses on: ◗ |Bedside to balance sheet ◗ Recruiting and retaining star employees ◗|Managing complaints and compliments ◗ |Media management – Good, bad and ugly Medical doctors get an opportunity to interact with business doctors at Medicall’s interactive healthcare intelligentsia meet. It will be refreshing for healthcare professionals to hear about fiscal health compared to physical health. Point of care professionals will learn and under-

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stand the role and impact of their actions on the hospital’s revenue. India doesn’t have an institution for leadership training in healthcare. BrainStorm Medicall’s healthcare leadership forum brings experts from far to share their expertise and experience.

BrainStorm Medicall workshops and seminars The show stoppers of Medicall are its seminars and workshops. Much care is put into this section to ensure they are not didactic and unidirectional but highly interac-

tive and responsive. The interactive healthcare intelligentsia at BrainStorm Medicall dishes out nuggets of wisdom in a nutshell. At Medicall, medicine meets management. A wide range of topics have been discussed at Medicall over the years. Topics ranging from - familyowned hospitals to financing o f hospitals, lean to six sigma, from marketing to mergers and acquisitions - have been discussed by eminent stalwarts like Dr Devi Shetty, Dr Namperumalsamy of Arvind

Eye Hospitals, to name a few.

Topics planned for this year ◗ Healthcare leadership forum ◗ Patient safety – workshop on medical errors ◗ Buyer’s bazaar ◗ Survival strategies for small and medium hospitals ◗ Doctors to entrepreneurs – A seminar exclusive for PG students ◗ Workshop for nephrology technicians Reportedly, close to 550 exhibitors will be displaying at Medicall 2014. The international pavilion

will include Bavaria, Germany, China, Taiwan, Malaysia, South Korea, Portugal, Italy, the UK, the US, Indonesia and Nigeria.

Footfalls Close to 12,000 footfalls are expected. The profile of visitors will include ◗ Doctors ◗ Hospital owners ◗ Hospital administrators and various stakeholders ◗ CEOs ◗ Dealers and distributors ◗ Manufacturers ◗ Bio-Medical engineers ◗ Academicians

MEDICALL 2014 SPECIAL

Role of IT in small-medium hospitals

PRASAD NAGOOL CEO, ITShastra India

IT is key to controlling cost and improving patient care INFORMATION TECHNOLOGY (IT) has the potential to improve the quality and efficiency of a hospital or healthcare centre. It allows healthcare providers to collect, store, retrieve and transfer information electronically. IT allows swift decision makings that are the key to controlling cost and improving patient care.

There has to be a blend of Needs and Wants as there is: ◗ Perceived quality of service by patients ◗ Industry practices ◗ Compliance and regulations ◗ The needs are also driven by the demographics i.e. city, location and locality

◗ CIA: Confidentiality + Integrity and easy availability of the data ◗ TPA billing (if hospital is enrolled with insurance companies) ◗ Compliance and statutory reports (Form 3C reports, Form F) ◗ Easy backup and restore

Main components of IT requirement

Contents of the software

Why do hospitals need IT?

◗ Hardware ◗ Networking ◗ Software/application

◗ For standardising the systems ◗ To make the system person independent ◗ Easy for a person to know the hospital philosophy ◗ Reduction in the erroneous billing ◗ Bill estimators helps in reducing friction at final billing ◗ Fraud prevention ◗ Ease in finding patient records ◗ High rate of TPA billing clearance due to computerised entry ◗ Auto generation of mandatory registers (Form F, 3C Registers) ◗ Compliance and regulatory requirements ◗ MIS reports

Infrastructure selection Infra selection consists of: ◗ Identification: Needs vs wants ◗ Proper vendor selection: Budgets, references ◗ Implementation: Implementation and training IT for smaller hospital is a challenging task as it demands striking right balance in the Needs vs Wants.

◗ Three main areas that should be covered are A. Medical records should cover history, investigations, diagnosis, medications and discharge details B. Accounting should cover billing, payment receivables, P&L statements, balance sheets,

Factors to consider before finalising software ◗ Ease of use to the staff (Fraud proof yet flexible)

MODULES REQUIRED: DEPENDING ON HOSPITAL BED SIZE Modules

0 - 20

21 - 35

35 – 50

Registration (OPD/IPD)

Examination

Billing

Inventory

Accounting

Radiology

Pathology

Operation theatre

Human Resource

Pharmacy

Reports

MIS Reports

Tally Integration

SMS Module

Backup / My Assistant

SELECTION OF INFRASTRUCTURE

payroll and tally integration (optional) C. Administration should cover consents, letters and certificates, staff scheduling and staff attendance ◗ Easy patient search: Provision to search patient by his name, mobile number, unique identification number (Patient ID), blood group, diagnosis ◗ Ease of use: Software should have less mouse clicks, more shortcuts and quick help ◗ Patient centric approach: In patient-centric approach, once a patient is selected on screen, all the services administered and required for him should be available in single screen, let it be regular services, radiology services, pathology services, inventory given to patient and operation charges. So there is no need to open new screens for each module entries, which saves lot of time. ◗ Roles and privileges: The software should have role- based access for security purpose so the administrator will have complete access to the system. The medical staff will have access only to medical records and other departments can access their part of jobs. ◗ MIS reports: The MIS reports should help in ■ Quick response to the hospital administrators helping them to significantly improve their operational cost ■ Evaluate hospital performance and cost ■ Projection of the long-term forecast. ■ Administration of hospi-

tals daily business transactions like financial, personnel, payroll, bed census etc.

Things to consider while selecting the vendor: ◗ Vendor’s installation experiences ◗ Terms of service and support ◗ Annual maintenance cost ◗ Client list

Implementation and training ◗ Setting up the system as per laid out requirements ◗ Awareness training for users ◗ Detailed training for selected person as per job category ◗ Feedback from users

Maintaining and updating IT infrastructure ◗ Hardware and networking: SLA with the vendors, buyback plans, phased out replacement ◗ Software: Patch updates, AMC with vendors, apply antivirus patches ITShastra established in 2001, is a one-stop solution to all IT design and development needs. As an ISO 9001, ISO 27001, CMMI Level 3 and Microsoft certified partner company based in Mumbai, ITShastra is incorporated with a mission to assist clients achieve business goals and get the maximum ROI on their IT investments. ITShastra is expertise in the design and development of robust and scalable web and mobile applications development.

MAIN COMPONENTS OF IT REQUIREMENT

Sr. No. Perceived quality of service by patients

Industry practice

Regulatory & compliance

Hardware

Networking

Software/Application

Handwritten bills with corrections

Computerised bills

TPAs Requirements

Server

Network Switch

Hospital management software

Patient discharge cards not legible

Computer generated discharge card

MLC case records

Computers

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Printer

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Patients records

Medical Records

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MEDICALL 2014 SPECIAL

Dawn of digital OR Hemal Joshi, Founder & CEO, SpectQual Healthcare, an Asiatic Medical Group Venture speaks on digitally integrated operation theatres and their importance in shaping future of surgery WE ARE in a digital age. Digitisation is everywhere in our life. The world around us has changed in last two decades especially thanks to some spectacular inventions or techniques invented in the field of Information and Communication Technology (ICT). Today, the sheer amount of data handled today is staggering and amounts to a “Digital Big Bang explosion.” Some notable inventions relevant to our discussion here are operating systems, search engines, data servers, mobile smartphones, tablets, mobile apps, high speed broadband and mobile Internet (2G, 3G, 4G), fiber optic cabling for networking, etc. Healthcare providers (hospitals, diagnostic centres, etc) have traditionally lagged behind other industries in terms of implementation of ICT Solutions both in data as well as image management perspectives. While most of the hospitals in India can now boast of at least a basic level of HIS (Hospital Information System), we still lag behind the rest of the world in terms of planning and implementation of image management and storage point of view, be it in the form of Radiology PACS (Picture Achieving and Communication System), Cardiology PACS or Operating Room PACS and Digital OR, to name a few. Like most of the other fields, we need to do a lot of “catching up” in image storage field before we can consider ourselves at par with other developed or developing nations. In this article, my focus will be on “Digitally Integrated Operating Rooms” or “Digital OR”. There is unfortunately no universally accepted definition of Digital OR, but it can be broadly defined as “an OR which is equipped to provide streamlined control of audio-visual and data information in a universally acceptable, Medical Standard digital format in the form of image and video archiving and communication platform that brings to-

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duration

Healthcare providers (hospitals, diagnostic centres, etc) have traditionally lagged behind other industries in terms of implementation of ICT Solutions both in data as well as image management perspectives. While most of the hospitals in India can now boast of at least a basic level of HIS (Hospital Information System), we still lag behind the rest of the world in terms of planning and implementation of image management and storage point of view, be it in the form of Radiology PACS (Picture Achieving and Communication System), Cardiology PACS or Operating Room PACS and Digital OR, to name a few gether multiple IT systems, processes and procedures from both inside and outside the healthcare facility on to one user friendly interface.” Sounds really complex, isn’t it? But in reality, it isn’t!

other words, The OR Complex has literally become “Complex” in management ◗ Digitisation also means more effective, less error prone, less time consuming and more patient friendly surgeries

The need for a DIGITAL OR

Scenarios in integration

◗ As discussed above just observe how the world has changed around us in last decade – Data Explosion equivalent to a Digital Big Bang ◗ Look at the inventions in digital arena which have transformed our lives forever: Google, smartphones, tablets, apps, cloud computing and storage, broadband (3G, 4G, 5G), high speed IP Network, data cabling, etc ◗ Concept of green hospital means paperless hospital and it means digitisation of OR procedures as an integral part of it ◗ Surgeons have to rely on more number of equipment and robotics to perform surgeries effectively, the complexity of which is increasing day by day as a result of new discoveries, researches and techniques. In

◗ No digital integration at all ◗ Level 1 of Digital Integration: Video routing, display and limited storage of individual systems inside OR ◗ Level 2 of Digital Integration: Limited scope of Integration of some modalities inside and outside OR ◗ Level 3 of Digital Integration: Fully digital, modularly upgradable digital OR

Criteria for opting for vendors for DIGITAL OR ◗ Open architecture ◗ Customisability & modularity ◗ Full system integration ◗ Investment protection/future proof ◗ Ease of use – single point of operation ◗ Good implementation with skilled IT team in perfect co-or-

dination with hospital IT Team ◗ Easy service and maintenance

Challenges in implentation of Digital OR in India ◗ Non-techno savvy management, seeing it as a “fancy tool” ◗ ICT is not a clear cut “returnon investment” tool ◗ We tend to satisfy present IT needs more than visualising future IT problems and make a provision for the same now ◗ It is a nightmare if existing OR is not planned with data cabling. Shutting down OR even for a day in a busy hospital disrupts entire surgical procedures calendar ◗ Digital OR technology even at Level 2 is relatively expensive to install and maintain ◗ No statutory compulsion as of now to digitise image management ◗ The complexity and cost of storage (physical, cloud) of huge files of radiology itself is a challenge, hospitals would want to avoid another challenge out of digital OR image storage which are typically bulkier than radiology because of HD,

Tips for avoiding mistakes ◗ Digital OR concept is the future – so wake up to it before it is too late ◗ Plan your hospital IP network with latest bandwidth/ technology ◗ Avoid common mistakes during planning and implementation of digital OR ◗ Hire a consultant if you are not equipped to deal with it on your own ◗ Plan not as per your present need, visualise 5-10 years’ needs and plan accordingly ◗ Customise digital OR concept for each OR as per your needs rather than generalising it ◗ Go for complete modular solution for super-specialty/complex OR situations for limited scalable solution for general/ non-complex OR ◗ Go for a vendor neutral solution ◗ Plan for storage and management for images SEPARATELY from Radiology PACS to avoid data explosion, mismanagement and infighting between departments ◗ Go for CE/FDA approved Medical Grade System, Displays and Software even if not compulsory in your country ◗ Look for a vendor who has sufficient experience and IT skills to handle such projects in your area. Planning, installation, maintenance and upgradation is critical in this type of project

Conclusion ◗ Digital operating room is logically the next big step to be taken by every healthcare institute in some form ◗ You will need it sooner than you think ◗ Plan in advance, avoid mistakes, take help from professionals/consultants if needed ◗ Enjoy the benefits of a Digital, seamlessly integrated OR in your setup in near future (if not already implemented !) hemal@asiaticmedical.in

HOSPITAL INFRA HIGHLIGHTS

Pergo launches vinyl planks and tiles Pergo vinyl flooring offers 14 different designs in two quality levels i.e. Optimum and Premium PERGO, PRODUCER of high quality laminate flooring has unveiled its latest vinyl flooring collection. It has now launched vinyl planks and tiles. Vinyl tile flooring is ideal for busy healthcare environments where hygiene and durability are of utmost importance. Pergo’s vinyl flooring can now reportedly be used in a wide range of healthcare settings including hospitals, nursing homes, clinics and health centres. Pergo Vinyl flooring offers 14 different designs in two quality levels i.e. Optimum and Premium. The products in the Optimum range belong to Class-33 with glue-down laying system, which is preferred for commercial areas. Pergo vinyl planks and tiles are apparently easy to install and durable,

polyurethane (PUR) coating over the top surface makes Pergo vinyl flooring so tough that it can withstand years of use and still look beautiful. “With Pergo vinyl planks and tiles, you don’t have to worry about bothersome main-

tenance, the vinyl flooring is easy to care and durable. It is the perfect combination of beautiful design and performance to revamp a place with the finest flooring,” claims a company statement. Vinyl flooring is attractive from a design

point of view and a residential warranty on ‘the product against surface wear’; is an added lure for customers. The crystal clear vinyl décor layer and bevels made possible by patented technology provide the vinyl floor a

distinctly authentic feeling. Being waterproof, Pergo vinyl planks and tiles are easy to clean and help maintain hygiene, making it suitable for healthcare environments. Formats available in Optimum range are: 1219 x 184 x 2.5 mm, 610 x 305 x 2.5 mm and Premium range are: 1225 x 178 x 5 mm, 1225 x 303 x 5 mm. The new product of Pergo is available since end of May2014. Pergo is a laminate flooring brand with prominent positions in North American and European markets. It is fast growing in India as well. The company develops, manufactures and markets flooring of high quality with distinctive designs and unique properties for both homes and commercial areas. EH News Bureau

Max launches campaign for emergency services Promotes its 'save the number' campaign at several locations of Delhi, including traffic signals through fridge magnets flyers and car stickers MAX SUPER SPECIALTY Hospital has launched a 'save the number' campaign. They were seen promoting the campaign at different locations of Delhi such as at traffic signals. The objective is to build awareness that one call to the emergency service number of Max Super Specialty Hospital can save many lives. The campaign urges the public to dial

40554055 in an emergency and promises that help would arrive in 30 minutes. Max claims that it has a very effective Emergency Response and Management System comprising world-class communication infrastructure as well as a fleet of advanced cardiac life support ambulances. Ambulances will be dispatched from the nearest Max Healthcare facility, to cut down the re-

sponse time taken in reaching the patient. The ambulance fleet reportedly has the latest equipment and is manned by a highly trained crew. Fridge magnets, informative emergency flyers and car stickers with the emergency number were being circulated at the ITO, Barakhamba Tolstoy's Marg, Pragati Marg in a bid to promote the campaign. EH News Bureau

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July 2014

ASK A QUESTION When and in which stage is equipment planning done? NARESH SHRIVASTAVA Gurgaon

Equipment planning is done early in the design development stage. This planning involves HODs, admin team and other medical staff. A series of meetings with staff members involved in finalising the list, the number and type of equipment are required. List depreciable and non depreciable hospital equipment? REENA SAHAY Bihar

Depreciable equipment are: Surgical apparatuses, lab therapeutic equipment and suction machines. It also includes physiotherapy equipment, refrigerator, general use surgical computers, electronic exchanges, typewriters, intercoms, office equipment, pharmacy equipment. Non depreciable equipment are: recurring in use five years lamps, waste bins, linen, sheets, blankets, catheters, surgical instruments, tableware, chinaware and kitchen utensils. These equipment are purchased through other than construction contracts. These are low cost equipment. What is your opinion on fire management in a hospital? DR KAPOOR Lucknow

The design and construction of every building structure should incorporate features for prevention of fire and fire loss: ◗ Considering the type and density of occupancy, lobbies, staircases, aisles etc. should be sufficiently wide to ensure easy movement of traffic at all times ◗ The design of the building structure should be planned to

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July 2014

allow pressurised exclusion of smoke in case of fire or smoke leak. ◗ Ideally a heavy duty elevator, especially for use of fire fighting personnel and used in case of emergency only should be incorporated. ◗ Adequate emergency rescue aids and suitable refuge area should be incorporated in the design. ◗ Safe and easy means of access should be provided to and in every place of work/occupancy. ◗ The floor should be designed in a way that they are free from obstructions, slip-resistant and even. Openings in floors should be securely fenced or covered. ◗ Staircases, ramps etc. should be provided with substantial handrails and other suitable support means to prevent slipping ◗ Easy access for servicing and maintenance of plant, machinery and buildings should also be incorporated in a design Can you explain different types of wastes in the hospital? ANKUR Bangalore

Wastes should be classified at the point where they are generated. According to the nature of the wastes and their source, they are classified as follows: ◗ Group I: those wastes that can be assimilated into urban refuse ◗ Group II: non-specific hospital wastes ◗ Group III: specific hospital wastes or hazardous wastes ◗ Group IV: cytostatic wastes (surplus antineoplastic drugs that are not fit for therapeutic use, as well as single-use materials that have been in contact with them, e.g., needles, syringes, catheters, gloves and IV set-ups). What is the job description of Nursing Superintendent? DR PARMAR

Delhi

◗ She will be responsible and overall in-charge of nursing services in the hospital ◗ She will report to the Medical Superintendent or Chief of Centres ◗ She will be responsible for implementing hospital policies in various nursing units ◗ She will formulate hospital policy, particularly those concerning nursing services ◗ She will recommend personnel and material required for various nursing service departments ◗ She will assist Chief of Hospital in recruiting nursing staff. ◗ She will carry out regular rounds of the hospital ◗ She will ensure safe and efficient care rendered to patients in various wards etc ◗ She will prepare budgets for nursing services ◗ She will be a member of various boards for linen and other stores ◗ She will be responsible for counselling and guidance of subordinate staff. ◗ She will attend hospital/intra hospital meetings and conferences. ◗ She will investigate all complaints regarding nursing care and personnel, and take corrective action. ◗ She will initiate and encourage research in nursing services. ◗ She will evaluate confidential reports of her sub-ordinate staff and recommend them for promotion ◗ She will maintain cordial relations between patients and medical social workers ◗ She will periodically interact with clinical heads to discuss problems in patient care. ◗ She will educate nursing staff of all categories by conducting awareness programmes on universal precautions

TARUN KATIYAR Principal Consultant, Hospaccx India Systems

Express Healthcare's interactive FAQ section titled – ‘Ask A Question’ addresses reader queries related to hospital planning and management. Industry expert Tarun Katiyar, Principal Consultant, Hospaccx India Systems, through his sound knowledge and experience, shares his insights and provide practical solutions to questions directed by Express Healthcare readers

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Capturing physical assessment and vital signs data is routine.

Accessing them should be too. Connect your patient vitals with Welch Allyn Connex®. Give clinicians immediate access to accurate patient vital signs with the Welch Allyn Connex Electronic Vitals Documentation System. With Connex EVD, you can capture vital signs with the wall-mounted Connex Integrated Wall System or Connex Vital Signs Monitor and wirelessly transmit patient vitals to your EMR in seconds—all without the paper, mistakes, or delay that come with manual transcription.

Visit www.welchallyn.com/connex to learn more today. Wirelessly transmit patient vitals to your EMR right from the bedside with Connex® vital signs devices

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BASIC OPTIMA & LIFE LINE HOPE

LIFE LINE HOPE ANAESTHESIA MACHINE

BASIC OPTIMA

Manufactured by

G S Health Care Products Pvt Ltd

Innovative world smallest leaser treatment for pain for different application by leading France Company sedatelec

ECG : With colour screen and 4-6 hrs battery back and touch screen with Innovative software base , 3-

HeartScreen 80G-L 3/12 - channel diagnostic ECG

6-12 channel print out through PC on live ECG .

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360 J, AED mode , Pacer, Spo2, 2.7 sec charging time , NIBP, Etco2, 12 Channel ECG, INNOCARE -S: World smallest

Cardio-Aid™ 360-B Biphasic debrillator

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paramonitor with only 300 gram with 6 hrs battery backup .

Stimulate the natural properties of cells by local applications: Pre-programmed: PREMIO 32 dans mallette Analgesia, Tissue Regeneration, Muscle Relaxation, Universal Programme SED 300dpi

TCB , UNIVENT TUBE with improved Bronchial Blocker for one lung Anaesthesia Size available 3.5mm to 9.0mm

InnoCare-S Portable monitor with 7" TFT LCD

AGISTIM duo Sedatelec 300dpi

Medicare System Inc. Office Add - 707 B, 7th Floor, Jaina Tower-II, District Centre, Janak Puri, New Delhi - 110058

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For Acupuncturist, Physiotherapist, Auriculomedecine practitioner, Dental surgeon, Midwife, Veterinarian,

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LIFE PEOPLE

Ramesh Kumar joins DocTree as Executive Chairman Kumar will be responsible for formulating the overall strategy for building up the start-up DocTree RAMESH KUMAR joins DocTree (doctree.in), the virtual hospital portal based out of Bangalore, as the Executive Chairman. Kumar will be responsible for formulating the

overall strategy for building up the start-up DocTree, and will be actively involved in developing industry and investor connect for the company. Kumar will also be a part of the board. “Having worked with various established entities across the world, it is time to give back to the society and therefore have committed to a concept like DocTree.in that holds the potential to reshape the healthcare access mechanism in India,” said Ramesh Kumar, Executive Chairman, DocTree. Prior to this, Kumar headed the Societe

Generale Global Solution Centre where he was instrumental in framing the company’s business plans and development approach. Ramesh was also an Executive Committee Member of Resources Group Worldwide with Societe Generale and an Executive Committee Member of Global Technology Division of SG-CIB (as Regional Director for its securities division in Singapore). Prior to Socgen, Kumar has been associated with Unilever India. He was a part of its technology division. Dr Sreenivasan Narayana,

Founder & CEO, DocTree said “Ramesh will be helping us channelise our resources in an effective manner and we are glad to have a visionary like him as a mentor to us” Kumar is also the Chairman of S4 holdings which is a key investor in DocTree. “doctree.in is a thoroughly researched concept that integrates IT into healthcare and is lead by a team of passionate and experienced team of doctors. The task at hand here is challenging but the team is committed to make a difference,” added Kumar.

Cardiac surgeon, Dr KM Cherian receives BACTS Award Chairman & CEO of Frontier Lifeline Hospital was honoured in recognition of his contribution to development of cardio thoracic surgery in Bangladesh

RENOWNED CARDIAC surgeon and Padmashri, Dr KM Cherian who is also the Founder and CEO of Frontier Lifeline Hospital was honoured recently with the BACTS award during an international conference held at Dhaka. This award was given to Dr Cherian in recognition of his contribution to development of cardio thoracic surgery in Bangladesh. The award was presented by Minister for Health, Mohammed Nasim and Minister of Shipping, Shahjahan Khan in the presence of National Professor Brigadier Abdul Malik.

Dr Cherian said, “I am extremely happy and honoured to have been recognised for my contribution. In fact this contribution has been achieved

due to my team’s support. This award has further motivated my team of doctors and me to work harder to ensure best medical care for our patients.

We will continue to discover breakthroughs in the field of cardiology that will benefit not just our patients but every patient in the world affected with heart diseases.” Dr Cherian is a world renowned and distinguished cardiac surgeon in India. He has won innumerable awards and has lot of first’s to his credit, be it the first paediatric heart transplant in India, first bilateral lung transplant, first successful coronary artery graft in India, first auto transplant or the first internal mammary artery graft in the country.

TRADE & TRENDS

Halma appoints Prasenjit Datta as MD of Halma India Previously he has worked in Senior Management as well as Sales & Marketing roles at 3M, Smithkline Beecham and Blue Star BEFORE JOINING Halma, Prasenjit was MD of Brady India. Previously he has worked in Senior Management as well as Sales & Marketing roles at 3M, Smithkline Beecham and Blue Star. He has a degree in Mechanical Engineering from the Indian Institute of Technology, Kharagpur and an MBA from the Indian Institute of Management, Ahmedabad. Halma Plc is an international market leader in safety, health and sensor technology. It is a public company listed on the London Stock Exchange and has over 4000 employees in 40 subsidiaries worldwide. Halma's subsidiaries make products that protect lives and improve the quality of life for people through innovation in market leading products which make its customers safer, more competitive and more profitable. These subsidiaries are assisting India’s economy in areas such as energy, manufac-

Halma, founded over 120 years ago, has a hub office in Mumbai turing, healthcare, water and waste treatment, construction and transport. Halma has a hub office in Mumbai.

About Halma Halma was founded over 120 years ago in 1894. A FTSE 250 company quoted on the London Stock Exchange, Halma is headquartered in London with over 4000 employees across the globe, customers in 160 countries and revenues of over 600 million pounds. Halma’s business is about protecting life and improving

quality of life for people worldwide. It does this through innovation in market leading products which make its customers safer, more competitive and more profitable. Halma is an international group of companies that make products for: ◗ hazard detection ◗ life protection ◗ personal and public health improvement ◗ environmental protection The company hasover 40 businesses in 23 countries and major operations in Europe, the US and Asia.It designs and manufactures products that are used to protect lives.

Contact Sunil Balan Marketing Manager HALMA INDIA B-1, 401 Boomerang, Chandivali, Andheri (East), Mumbai – 72. B: +91 22 6708 0400 /6765 0431 M: +91 77381 61211 sunil.balan@halma.com www.halma.com

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REGD. WITH RNI NO.MAHENG/2007/22045. REGD.NO.MH/MR/SOUTH-252/2013-15, PUBLISHED ON 8th EVERY MONTH & POSTED ON 9, 10 & 11 EVERY MONTH, POSTED AT MUMBAI PATRIKA CHANNEL SORTING OFFICE.