Express Healthcare (Vol.9, No.12) December, 2015

VOL.9 NO.12 PAGES 76

www.expresshealthcare.in DECEMBER 2015, `50

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CONTENTS Vol 9. No 12, DECEMBER 2015

Chairman of the Board Viveck Goenka

FRUGAL INNOVATION: KEY TO INDIA’S HEALTHY FUTURE?

INTERVIEWS P12: SHASHANK ND Founder & CEO, Practo

Sr Vice President-BPD

Neil Viegas Editor

P34: DR ATUL KHARATE

Viveka Roychowdhury*

State Tuberculosis Officer and Directorate of Health Services, Madhya Pradesh

Chief of Product Harit Mohanty BUREAUS Mumbai

P36: SIDDHARTHA

Sachin Jagdale, Usha Sharma,

BHATTACHARYA Country Director, ACCESS Health International

Raelene Kambli, Lakshmipriya Nair, Sanjiv Das Bengaluru Assistant Editor Neelam M Kachhap

P38: RAJIV BAJAJ

DESIGN

GM India, Stratasys India

National Art Director Bivash Barua Asst. Art Director Pravin Temble

P44: DR KALYAN KRISHNA VELIVELA

Senior Graphic Designer Rushikesh Konka

Medical Coordinator, Médecins Sans Frontières (MSF)

Artist Vivek Chitrakar, Rakesh Sharma Photo Editor Sandeep Patil MARKETING Regional Heads Prabhas Jha - North

Frugal innovation could be the answer to India's unmet healthcare needs, provided it is backed by sustainable business strategies| P18

P48: JASBIR GREWAL Head, Fortis Charitable Foundation and Executive VP, Fortis Healthcare

Dr Raghu Pillai - South Harit Mohanty - East & West Marketing Team

KNOWLEDGE

IT@HEALTHCARE

STRATEGY

LIFE

Douglas Menezes G.M. Khaja Ali Ambuj Kumar E.Mujahid

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BOSCH FUNDUS CAMERA: IMPROVING EYECARE

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IOT: OPENING A WORLD OF POSSIBILITIES FOR INDIAN HEALTHCARE

Arun J Ajanta Sengupta PRODUCTION General Manager B R Tipnis

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CSR IN HOSPITALS: A CHANGING PANORAMA

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INFANT NUTRITION: A MUST TO STEER INDIA’S NUTRITION AGENDA

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STRONG LAB SYSTEM: CRUCIAL IN CONQUERING INFECTIOUS DISEASES

Manager Bhadresh Valia Scheduling & Coordination Ashish Anchan CIRCULATION Circulation Team Mohan Varadkar

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DR SUDARSHAN BALLAL APPOINTED AS CHAIRMAN OF MHE

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PHILIPS INDIA APPOINTS V RAJA AS VICE CHAIRMAN AND MD

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DR SURESH ADVANI: AN UNSHACKLED SOUL

Express Healthcare® Reg. No. MH/MR/SOUTH-252/2013-15 RNI Regn. No.MAHENG/2007/22045. Printed for the proprietors, The Indian Express (P) Ltd. 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 © 2015 The Indian Express (P) Ltd. All rights reserved throughout the world. Reproduction in any manner, electronic or otherwise, in whole or in part, without prior written permission is prohibited.

EDITOR’S NOTE

High-tech vs high-touch

A

s we gear up for our 16th Anniversary issue this January, we decided to start a new venture: Healthcare Challengers, a platform to bring together entrepreneurs who challenge the norm in healthcare and the funders who take a bet on them. In time, we hope to take this forum across the innovation hotspots. Look out for more details of the first Healthcare Challengers get together on our site and in the January 2016 issue.

However, one of the key challenges to innovators is sustainability as the start up sector in general has a high failure rate of 90 per cent, which means that one out of 10 will fail.

Though, in the case of medical technology start ups, it’s a mix of good and bad news. The bad news is that medtech has more entry barriers. Most innovations in this space need in depth technical/medical knowledge, and considerable money and infrastructure to take it even to a prototype stage. So, medtech start ups took time to make their mark but now, almost every start up seems to be targetted at a gap in the healthcare delivery ecosystem. The good news is that the failure rate is lower, possibly because the ones who do venture into this space, have done their groundwork more thoroughly.

But all the fire in the belly of healthcare entrepreneurs and all the high tech innovation will not be able to change attitudes of healthcare practitioners. For example, three years after the Government of India declared TB a notifiable disease, TB case notification rates remain low among private healthcare practitioners.

A research article published in April this year in PLOS One, sums up the dilemma aptly: "They Know, They Agree, but They Don't Do" - The Paradox of TB Case Notification by Private Practitioners in Alappuzha District, Kerala." Only three TB cases were notified by private practitioners in this district in 2013, even though the public sector reported 2000 TB cases on an annual basis.

Even though the PLOS One study might not be considered statistically significant since it covered a relatively small number (169 private practitioners) and was confined to one district, the findings resonate with other data. In line with the PLOS One study, conducted between December 2013 to July 2014, it is worrying that of an estimated number of 2.1 million people developing TB each year, the Revised National Tuberculosis Control Program (RNTCP) reported notification of just 1.4 million TB patients in 2013. It means that a good one third, around 40 per cent, called ‘missing’ TB patients, are not within the ambit of the RNTCP and are thought to be managed by the private

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We will need a mixof high-tech innovation and high-touch intervention to make healthcare more affordable and accessible in India

health sector. Thus, unless private practitioners also adopt national standards for TB care, we will be nowhere close to controlling, forget, eradicating TB from India.

It is important that these ‘missing’ TB patients are covered by the RNTCP so that they can access the recommended treatment regimens, without which they might end up worse off. But notification has not taken off for various reasons.

As Bharathi Ghanashyam, Founder/Editor of Journalists against TB points out, checks and balances are not in place and there is a fear among private practitioners of the 'fence eating the crop', i.e. of losing their patients to the public sector.

For notification to be successful and effective, it is vital for the authorities to put in place, systems that are accountable, simple, and can assure confidentiality as well as the confidence to private practitioners that they will not lose their patients to the public health system, summarises Ghanashyam.

But even with these obstacles, some projects have shown the way. Dr Oommen George, Project Leader, of USAID’s SHOPS -TB Prevention and Care Initiative suggests that an amended title reflects a solution: “They Know, They Agree, but They Will Do, if Meaningfully Supported by an Interface Agency”. The Strengthening Health Outcomes through the Private Sector (SHOPS) project he is referring to worked with RNTCP in Karnataka. Running from October 2013 to September 2014, the SHOPS project chose Karnataka because its annual TB total case notification rate of 98 per 100,000 people, is one of the lowest among the southern states of India. Dr George's study report details how capacity building of private healthcare practitioners (HCP) was institutionalised through engagement of private medical colleges, and continuing medical education (CME) programmes, aimed at medical students, college faculty and private clinicians, were accredited by the Karnataka Medical Council.

The study results were encouraging, with the team managing to network nearly 1000 private providers, demonstrating means to increase TB detection under RNTCP, as well as identifying many of the ‘missing’ TB patients through private provider engagement. Importantly, these interventions halved delays in TB diagnosis and initiation of treatment. Thus, we will need a mix of high-tech start up innovation and high-touch intervention (like the SHOPS project) to make healthcare more affordable and accessible in India.

VIVEKA ROYCHOWDHURY Editor viveka.r@expressindia.com

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LETTERS

AMITABH BACHCHAN NOVEMBER 2015

Bollywood superstar and UNICEFGoodwill Ambassador (speaking at the launch of a media campaign on Hepatitis-B in Mumbai)

WELL ARTICULATED

C

ame across this wonderful write up on Big Data and healthcare and liked the way the concept is articulated .

Wonderful job done! Looking forward to the next big!

Dr Vijay Raaghavan Principal Consultant, PwC

I have battled Hepatitis B following a bad blood transfusion; it has highlighted to me how a small oversight during growing up years can prove to be detrimental to not only one’s own life but also others. Immunisation against Hepatitis B is a very personal issue for me, and I am very happy to associate with Ministry of Health and Family Welfare and UNICEF India to narrate my story to the Indian population to create awareness about this cause

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‘The foundation of every start up should be the vision to solve an existing problem’ Shashank ND, Founder & CEO, Practo in an interaction with Raelene Kambli shares Practo's success mantra and provides tips for start-ups in India to sustain their business

What was Practo's business plan at the initial stage and how did you develop it further? Explain to us your business model and what competitive edge do you have over your competitors?

Practo is in a unique position of having a globally respected strong B2B software product (Practo Ray) that is tightly integrated with its much loved consumer offering (Practo Search) – creating the world’s first and only healthcare hyper loop that is connecting the entire healthcare ecosystem and is helping millions of consumers make better healthcare decisions.

When we launched Practo Ray, we made sure that we eliminated all the pain points that doctors faced on a daily basis. We chose to keep the software cloud-based so that doctors didn't have to worry about software updates, hardware requirements, data security and data backups. This enabled doctors to focus on patients rather than having to focus on running a clinic.

To enable consumers to find the right healthcare practitioner, we have Practo Search – our healthcare discovery platform that allows consumers to find the right doctors and book instant appointments. We’ve taken the route of listing all doctors for free (post verification of-course), we also don’t charge patients to book appointments or for doctors to receive these appointments.

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The entire process is completely free – because this ensures that patients have the widest possible choice.

With a few clicks, patients can book an appointment with a doctor without waiting in long queues. They can also do diagnostic search by the test name instead of lab name to see the list of labs near them that offer the needed test. They can check the quality of the lab by reading through the accreditation information, see real high quality photographs and filter results by proximity, home pickup facility as well as price. All this can be done in a matter of seconds.

We recently launched Practo Ray for specialities, which will provide better tools to doctors and significantly improve patient care for some of the biggest healthcare issues plaguing our country, including controlling lifestyle diseases and ensuring immunisations for infants and children.

Tell us about your recent acquisitions?

We believe acquisitions are a fantastic way to add world class, like-minded talent to our team. It gives us a fast way to scale and the ability to further accelerate our roadmap. We have recently acquired four companies in the past six months.

Fitho will help expand our offerings and move into the preventive healthcare space.

Genii aims at strengthening

We have been active on the acquisition front. We believe acquisitions are a fantastic way to add world class like-minded talent to our team

the tech team at Practo and help accelerate time to market across enterprise segment Insta Health will enable Practo to transform the hospital industry globally Qikwell’s acquisition was a move to penetrate deeper into the enterprise segment, especially hospitals, clinics and diagnostic centres, after extending our stranglehold over individual doctors. The Qikwell product recently reduced waiting time for patients from 30 minutes to eight minutes. We are bringing systemic efficiencies into the hospitals, in the way they are run.

Practo now has four offline revenue models, hence we do not need to generate e- commerce revenues or charge our online clientele — patients and doctors. Practo Ray is one revenue stream that brings in cash from the doctors and clinics.

Practo Reach is a premium listing and subscription-based service for doctors. Qikwell has its own revenues from hospitals that use its products as does Insta Health.

In August this year you have raised your series-C funding of around $90 million, how are you utilising these funds for expansion? What is your expansion strategy?

We received our third round of funding of $90 million in September, 2015 from Tencent, Sofina, Sequoia India, Google Capital, Altimeter Capital, Matrix Partners,

Sequoia Capital Global Equities and Yuri Milner.

The biggest part of the investment will go into building the best products that will transform healthcare for consumers around the world, this includes new products and building on the existing products that we have. We plan to add more features and several more categories including hospitals, more diagnostic centres as well as spas, salons, wellness and fitness centres as well. We also continue to add top-notch talent to its world class team of over 2000 Practeons. We aim to add over 1000 Practeons to this number by next year. We will be recruiting a lot of engineers, growing our technology and product teams and adding many more Practeons who can help us bring groundbreaking products for a global audience.

The next is to scale up the geographical expansion, the footprint will expand from the current 50+ cities and 15 countries to over 100 Indian cities and more countries across South East Asia, Latin America, Middle East and Eastern Europe.

The third one is to acquire more companies with whom we can work together to solve the healthcare needs for billions of people across the globe. We have been active on the acquisition front. We believe acquisitions are a fantastic way to add world class like-minded talent to our team. It gives us a fast way to scale and the ability

MARKET to further accelerate our roadmap.

At Practo, we envision a world where technology will help consumers find the best doctors with a few clicks.

Generating, accessing and storing health records would be entirely digital. Patients will have a single health account linked to their families that will store their health information securely, and provides helpful information (prescription reminders for example) in a timely manner (prescription reminders to take medicines for example) to help people live healthier, longer lives.

Apparently, a large number of start-ups fail within their first five years, but Practo has survived and even thrived. So, what is your strategy for sustainability?

One of the most important things I’ve learnt in this journey is something we’ve put as one of the core values at Practo – we call it ‘First Principle Thinking’ – what this essentially means is that you must think deeply about whatever it is you’re trying to do – a product you’re making, the problem you’re solving and if you think deep enough, you will uncover the real insights and make sound decisions.

For example, when we built Practo Ray, our SaaS product, the entire world told us that building software for doctors won’t work and no one would buy it – we looked at the problem and found that in fact, the reason why doctors hadn’t adopted the technology was because no one had ever built a product specific to their unique workflows – up until Ray, it was a technology that had failed doctors – so we fixed it and sat with doctors in their clinics for hours to understand the problems and build our product to solve them. When we were building Practo Ray, we already had the vision of building a global company, so we made sure that we built a product that was scalable and replicable in multiple countries across the globe. The same software that is used by a doctor in Shivajinagar in Bengaluru is used by doctors in Singapore, Malaysia, Indonesia and Philip-

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pines (with a few language tweaks) Second, when we were looking at a sales model, again the whole world told us that no one has ever made a successful feet on street sales mode for a SaaS product, our first principle thinking told us that if doctors aren’t online, it made no sense to stick to online sales. We still went ahead and launched Practo Ray - the world’s first SaaS based platform in healthcare. The first version of Practo Ray was created from scratch, based on the feedback we got from doctors. Over the next few months, at some point or another we got validated. The first validation came from the users. In Bengaluru, there were 10-15 doctors we sold the software to at first. Changing the system is done best with a bottom-up approach. For two years we ran it on our own, without any money. Then it just took off. We did what was right.

We kept our ego aside and ran the business. Validation came every two to three months and accordingly we made changes to the product based on direct feedback from the doctors.

Today we have over 40 million appointments booked on Practo.

What kills startups? And are these risk factors applicable to healthcare startups as well?

The foundation of every start up should be the vision to solve an existing problem in a specific industry. When founders lose focus of that vision that is when the problem arises. Along with solving a meaningful problem, companies should put in all their efforts towards building a great product. In order to do this, you must hire ‘A’ players. Fund raising is something that will follow if the product is good and the customer base is loyal and content with the product offerings. The aim of every start up, irrespective of it being a healthcare start up or any other should never be to make money, but to solve problems, build great products and follow a remarkable culture within the organisation.

What needs to be done by

At Practo, we envision a world where technology will help consumers find the best doctors with a few clicks

the management to sustain a startup business and scale up?

One of the most important things I have learnt is to build a very strong culture in the company. Every Practeon is aligned with the culture at Practo. Culture is a key difference between good and great companies. At Practo we've always had a 'do- great' culture which means a person wants to be the best at whatever they do not for want of reward or recognition (which they get) but because it is what they expect of themselves. I believe in a passionate, superflat, meritocratic organisation. I don't believe in average or good, I believe in great. At Practo, we look for people who want to solve humanity's biggest problems — who have a purpose — those who want to leave the world better than they found it. I think meaning and impact are the things that keep people going. I think this is what makes people want to come to work everyday.

At Practo we only hire A players, people who can do that specific task better than me.

We trust, empower and instill a sense of responsible autonomy so that every team can take real ownership and drive things extremely fast – while being aligned to the vision of the company. To help us scale faster and take the best management decisions, we have a simple VUPIM hierarchy, You

have to optimise the Vision first, then the Users, then Practeons, then Investors and then Me ( the individual being).

This has helped Practo become the world’s largest appointment booking platform.

As a company, one of the most important things we've done is create the world's first healthcare hyper-loop, a seamless integration between our consumer and B2B product that enables millions of consumers to find the right healthcare practitioners besides helping practitioners to treat their patients better and more efficiently.

We recently received a 100 per cent rating on Glassdoor, I think it is a reflection of the strong leadership at Practo.

Every day, I am inspired and excited how Practeons helped to make a positive difference in the lives of billions around the world. I have always believed in motivating them to push their boundaries, work on something better, on something that can change lives and on something global.

What are the three must do things for a healthcare start up to survive in India?

For any start up to survive, it is vital to do the following things: Firstly, always optimise for the vision. Articulate the Vision continuously and ensure each step you take is towards this.

Vision helps align the entire team behind a common purpose. Secondly, solve hard problems. At the start, try picking the tough problems to solve. These are usually the ones no one else would have tried solving. Ask yourself, ‘Why hasn’t anyone done this before?’ Logically, due to technology advancements, problems that were harder to solve so far, would become easier now.

Third, hire A players only.

That should be one of your top priorities. Only get the best of the best. They can give you exponential growth. Ensure they buy into the vision of the company and focus equally hard on retaining them. One of the keys to retention is to build a great culture from day one. It will remain through the life of the company.

And finally, have fun. You will spend long hours doing this so make sure you love doing it and are excited by it. There is no room for half heartedness.

We are seeing that a lot of investors are betting on promising Indian startups. What is your opinion on the same?

I have been on both sides of the start up sector, three years before the investment boom and four years post the influx of funds. I have seen how dramatically things have changed.

One of the major drivers is the number of internet users that India has witnessed. Entrepreneurs have existed for the past twenty years, but around 2011 because of the mobile phone and internet boom, the number of internet users shot up. Today, we are sitting at around 300-400M internet users, which is larger than the population of the US. There is no other phenomenon that has witnessed a 10X change in the three years. The advent of mobile phones and internet users has been the backbone of this huge surge in start ups in India.

India is slowly becoming the start up capital of Asia. Entrepreneurship is a lot harder than building a business but it’s definitely getting easier now.

Building a business and building a start up are two different things. Building a startup is like building a business on steroids.

You have to scale up and move fast. India has a lot of fundamental problems, but India also has a lot of hard working and smart people who can solve these tough problems.

They need some capital and some support. Luckily we have the right society fabric as well as the right governance model that gives us the freedom as individuals to go solve those problems. India is also a large country, one ground breaking idea can become very large.

India is self-sustaining in that matter. Additionally, India is also an English-speaking country, which is a huge benefit. I think the current environment is great to support a vibrant start up ecosystem for the next 10-20 years. raelene.kambli@expressindia.com

MARKET TREND

Frugal innovation: Key to India’s healthy future?

Frugal innovation could be the answer to India's unmet healthcare needs, provided it is backed by sustainable business strategies, finds Raelene Kambli WAY BACK in 2009, watching the Bollywood movie '3 Idiots', I remember scoffing at one of the movie sequences where the protagonist Aamir Khan facilitates the delivery of a baby using a vacuum cleaner and an inverter made from a car battery. I somehow could not relate with the idea that a vacuum cleaner could be used as a suction pump to deliver babies. However, at that time I settled down to thinking that after all it’s from a Bollywood movie where anything is possible.

Fast forward to 2015, in October, I attended an innovator's exhibition at Somaiya College Campus in Mumbai where around 100 students from various institutions across the country had gathered to demonstrate their innovations in areas of healthcare, art, consumables and more. There were some cool healthcare innovations such as a blood flow analyser made using laser technology, a virtual navigation stick for the blind created using ultrasonic sensor, diagnostic protocols for malaria developed using fluorescent microscopy etc., all made at a very low cost using simple technologies. This got me hooked to the subject of frugal innovation or ‘Jugaad’ in the Indian parlance. On further research, I found a host of whitepapers that spoke about people in remote villages of India converting polystyrene boxes into infant incubators to save life of babies born with low birth weight, medical technology giants creating ultralow-power screening

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devices to suit local conditions, so on and so forth. These citings have made me realise that India's acclaimed resourcefulness can lead to great home-grown innovations with the potential to solve the country's unmet healthcare needs and become a globally relevant business methodology.

For instance, the Jaipur Foot. First invented in the 1960s, it was developed to suit the needs and requirements of the people seeking it. This innovation changed the lives of hundreds of thousands of amputees. But, what makes this innovation stand out is its cost effectiveness that earned it international acclaim. Today, a complete Jaipur Foot limb costs less than $40 including a prosthetic foot made of wood and sponge rubber, which itself costs less than $ 5 and can be made in under three hours.

Today, employing a hub-andspoke delivery model, the makers of the Jaipur Foot, Bhagwan Mahaveer Viklang Sahayata Samiti (BMVSS) reach out to patients through 22 centres across the country and more than 50 mobile camps are held in remote rural areas. This highly coordinated network allows the organisation to divide its resources efficiently, reducing overhead and human capital cost, without limiting the reach of its services.

Another similar example is Arunachalam Muruganantham's low-cost sanitary pad making machine which played a pivotal role in improving menstrual health for rural women, not only in India but

met healthcare needs of those at the bottom of the pyramid (BOP) and the other that bears witness to the changing business scenario. Let’s first understand how frugal innovations can serve the underserved.

Driven by needs

also in 17 developing countries including the African states.

Muruganantham is successfully running a self-sustaining sanitary napkin business, called Jayashree Industries. It has over 2000 units across India, including the Andaman and Nicobar Islands, employing 21,000 women. He was also named one of Time Magazine’s 100 Most Influential People in 2014 for his innovation and efforts. Like these examples,

there are many stories that speak of India's frugal engineering skills and its tremendous capabilities to disrupt various market. But is India's healthcare sector equipped to drive this growth and sustain it in the long run?

Express Healthcare, in this article, seeks to find answers to this question; however, in the process finds two important aspects to the issue. One that helps in meeting the un-

Necessity is said to be the mother of all inventions and it perfectly describes the case of India's healthcare scenario currently. Driven by factors such as resource scarcity, rising cost and lack of access to health services in the rural areas, India is looking at frugal innovation for deliverance in every spectrum of healthcare.

Says Vinayak Nandalike, CEO, Yostra Labs, “India imports more than 70 per cent of the medical equipment which is designed for healthcare setups of developed economies. From clinical needs, patient affordability, accessibility and healthcare setup perspective, India presents certain unique challenges that makes it difficult for the global medical device manufacturers to go with a ‘one size fits all’ approach to medical device development. Growing need for affordable healthcare in India is opening up new avenues for entrepreneurs, and established medical device manufacturers alike to employ frugal innovations which will disrupt the market and at the same time have significant societal impact”.

“I see it in all areas of healthcare, from diagnostics to ocular, to artificial limbs i.e prosthetics, to stents or other tools required in surgery and

MARKET to even telemedicine so that medical treatment could be brought to the remotest locations at a fraction of the cost using modern technologies like the cloud,” opines, Sanjeev Saxena, Chairman and CEO, POC Medical Systems.

Adding to this, Elizabeth Bailey, Director, CAMTech informs, “Frugal innovation is happening across the healthcare continuum in India, driven by the vast array of needs.

One common theme that has emerged is innovations addressing the shortage of healthcare workers. There is a need to create smart products that do not rely on a high level of skill by a clinician. This kind of task shifting will help bring quality healthcare to underserved populations. Again, the focus is on simplicity and easeof-use, combined with affordability. We see this in mobile health applications that aid in decision support, all the way to interventional devices that address postpartum haemorrhage and new diagnostic tools for cervical cancer diagnosis.

The technology innovation enables people with less skill to provide the same level of care as a trained physician, and we will see more and more tools working toward that end”.

Citing few examples, Probir Das, MD, Terumo adds, “India has already started the process of innovating to deliver low cost, high quality healthcare to increasing populations. Our lowest procedural costs as compared to the rest of the world, gradually succeeded in health schemes such as Rashtriya Swasthya Bima Yojana (RSBY), Yeshaswini, Arogyasree, etc.

These are a testimony to the innovation that is unfurling on the delivery side.”

Some noteworthy frugal innovations making an impact on public life in India today are as follows: LifePhonePlus: A team of Intel researchers in India is finding ways to tackle healthcare access problems in the hinterlands of India. With LifePhonePlus, patients can keep track of their blood-glucose levels, undergo electrocardiography testing (ECG) and obtain a specialist’s advice without leav-

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ing the town. The device was launched in 2013 and last year the device won the South Asia E-Health Summit Award for mobile health innovation.

Kumar Ranganathan, leader of Intel India’s biosignaling lab who has led this project says LifePhonePlus has been successful because it was

India's home-grown innovations has the potential to solve the country's unmet healthcare needs and become a globally relevant business methodology

developed specifically for Indian patients by Indian innovators who understand the ground realities and have first hand knowledge of the country’s healthcare problems.

It was developed and manufactured in the most basic and least expensive manner possible. Currently, various clinics

MARKET

One common theme that has emerged is innovations addressing the shortage of healthcare workers Elizabeth Bailey Director, CAMTech

It is just a matter of time before India is recognised globally as the next health innovation hub Probir Das MD, Terumo

India has the opportunity to leapfrog ahead.

However, it is important for India to simplify its laws and administrative procedures Sanjeev Saxena Chairman and CEO, POC Medical Systems

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and hospitals currently provide diagnoses to patients using the device.

GE's innovations: GE revamped its operations in India to tap into the country’s growing demand for medical devices. GE isn’t just marketing low-cost medical devices in India. The company is also taking account of local conditions when it develops and tests new products, conditions which include power outages, voltage fluctuations, high levels of dust and pollution, and intensive equipment use. One of the most successful products to come out of GE’s efforts in the field of ‘frugal innovation’ is the Lullaby baby warmer, which provides direct heat in an open cradle and is used to help new-born babies adjust to room temperature.

The Lullaby warmer is cheap compared to the baby warmer that GE sells in the US, that starts at $12000 and which, on top of the basic warming function, performs other functions such as monitoring a baby’s pulse and weight. The Lullaby warmer was launched in India in May 2009 and is now sold in 62 countries, including Belgium, Brazil, Dubai, Egypt, Italy, the Russian Federation and Switzerland.

Another example is, GE's MAC 400 Electrocardiograph machine that takes a $10,000 device, adapts printing technology used in India’s bus terminal kiosks, and turns it into a $1,500 device, or just $1 (50 rupees) per patient. More recent versions bring the cost down to just Rs 10 per patient.

Two-tier telecardiology framework: In a bid to provide reliable healthcare delivery in remote areas at low cost, the faculty from IIT Hyderabad are developing a two-tier, telecardiology framework where ECG records can be transmitted even when available resources such as power and bandwidth are limited. The device has the capability of verifying sample signals as normal or abnormal. Using minimal power and bandwidth, the signals can be transmitted to the local sub-centre. The sub-cen-

Picture for representational purpose only

tre will evaluate this data according to the algorithm. If the signal is abnormal, it will be sent to the diagnosis centre. The technicians at the diagnosis centre can look at the reconstructed signal acquired by other devices.

After this, it’s easy to diagnose the issue and send back the diagnosis through SMS. This saves a lot of time so that patients with serious issues can immediately meet a doctor to get treatment. This venture is funded by the Ministry of Communication and Information Technology (MCIT) under the Department of Information Technology.

Polystyrene baby incubators: In a tribal village called Dahanu in Maharashtra, students from Boston University’s School of Public Health use polystyrene (better known as thermocol, or styrofoam) boxes as baby incubators. In this particular village, babies are born with low-birth-weight and their chances to survival stands extremely low. But a grassroots intervention is helping reduce the risks. These boxes look very similar to the beer coolers that you find in the United States and cutting four holes on two sides is all that is done to convert it into a baby incubator. The project was initiated by SR Daga, formerly a paediatrician at Cama Hospital in Mumbai, India, whose goal was to find an inexpensive way to prevent hypothermia among babies in low-resource areas. The polystyrene boxes are a good answer: they are inexpensive, easily accessible, and can be

used by anyone.

Narayana Hrudayalaya’s low cost cardiac surgeries: The hospital’s cardiac unit began providing heart surgeries costing between $2,000 and $5,000, compared with $20,000 and $100,000 in the US, by using philosophies of mass production and lean manufacturing. For poor patients, it provides several free operations per week and is still able to turn a higher profit margin than the average American hospital.

All these above mentioned innovations provide good quality services at low cost and in a small environment footprint. Further on, these exemplars of frugal innovation also reflect a new mindset that today's innovators, entrepreneurs and organisations possess which explains the second important aspect to this concept - creating a business model.

Driving business models Innovation and leadership advisors, Navi Radjou and Jaideep Prabhu explain that frugal innovation is more than a strategy. It denotes a new frame of mind to do business: one that looks at resource constraints as opportunities rather than obstacles. These innovators do not seek to charm customers with technically sophisticated products, but instead strive to create good quality solutions that provide greater value at the lowest cost. They further believe that frugal innovations bring about a radical change in the business environment.

Agreeing to this doctrine and

applying it to the Indian context, Gaurang Shetty, Research Innovation Incubation Design Lab, RiiDL, Somaiya Vidyavihar says “Frugal in the Indian context is not necessarily a product.

Frugal solutions are just one dimension of a larger picture.

Frugality can extend to the entire supply chain and even be established as a business model. This concept can be applied to the value you can bring to customers.” The Jaipur Foot, Jayashree Industries, Narayana Hrudayalaya Group and Aravind Eye Care have already set precedent in this area. They have created a business model that thrives on frugal innovation and what gives them sustainability is their attitude to continuously foster a frugal culture in their own organisations.

Therefore, it’s important to note that for any frugal innovation to sustain in the long run, innovators, entrepreneurs and organisations will have to adopt a culture of constant innovation to match up to the increasing needs of those at the bottom of the pyramid. Failure to do so might cause the entire concept to collapse. This comes as a warning sign, especially for start-ups in healthcare that are built on the premise of frugal innovation.

Cashing in on opportunities Nonetheless, experts believe that frugal innovation is a trend that’s here to stay.

Giving a global view, innovation incubator, Bailey mentions, “CAMTech believes the future of healthcare innovation will see clinicians, sitting side by side with engineers and entrepreneurs, co-creating new medical technologies that will transform the way healthcare is delivered globally.”

Saxena agrees with Bailey on the potential of India's frugal innovations. He further compares other markets and speaks about where the opportunities lie. He says, “I think, India has the opportunity to leapfrog ahead. However, it is important for India to simplify its laws and admin-

MARKET istrative procedures. India is still living in the dark ages, where India says it encourages innovation, however it truly doesn't as it doesn't give any room for failure to its entrepreneur. If one fails they are penalised. In the US, if a company fails the entrepreneur who has already lost his company and his money does not have to worry about paying back debts to the banks and the rate of change (ROC) etc., an unnecessary burden which prohibits people from taking risks and without risk there is no innovation. China, on the other hand, gives grants to its people to start companies and doesn't expect it to be paid back. Same is the case in Mexico and Brazil. So, while China had a setback to its economy, you find it’s bouncing back as the innovators and entrepreneurs were never penalised when their companies failed. About opportunities for India, our country is speeding ahead. India has a major advantage. As Prime Minister Modi said in his speech at the SAP centre in California, "We have a major brain gain. Now India gets to harvest the brains it sent to US decades ago." It doesn't mean that the people come back to India but it means they utilise the knowledge that they have gained to help India leapfrog ahead of others.”

“The solutions that will make us survive therefore will build a ‘Create in India, Create for the World’ momentum, much larger than just ‘Make in India’ or ‘Made in China’. Yes, there are bottlenecks to that.

Our academia – business – government partnerships are still a long way from ideal; our healthcare procurement systems do not encourage innovation; we have shortage of seats and programmes in Biomedical Engineering & Material Sciences and this list could go on. But we have started addressing these problems.

The stakeholders are coming to a symphony of togetherness.

Therefore, it is just a matter of time before India is recognised globally as the next health innovation hub,” sums up Das. On the government's front, campaigns such as Make in India and Digital India are

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December 2015

opening up avenues for homegrown innovations. In a recent development, Communications and IT Minister Ravi Shankar Prasad at the Intel's innovation event announced that the Department of Electronics and IT (Deity), in order to promote innovators in various fields, is developing a separate portal

Frugal innovation is a trend that is here to stay

www.hmdhealthcare.com

where people can put up their innovative products to receive government help. Indeed, this is a welcome move.

All in all, the industry is convinced of the potential of frugal innovations in healthcare. This indeed keeps the buzz alive for frugal innovations to flourish.

However, with several health-

care start-ups going bust, a cautious approach is also advised. Innovators, entrepreneurs and organisations must spend time to test the product and test its viability, rather than hastily rush to the market with their innovations to meet business objectives. raelene.kambli@expressindia.com

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MARKET PRE EVENT

AHA to organise conference on 'Safe and Sustainable Hospitals' The theme of the conference is 'Innovations and Updates in Hospital Management' ACADEMY OF Hospital Administration (AHA) - Mangalore Manipal Chapter is organising a two-day national conference on 'Safe and Sustainable Hospitals' at Yenepoya Medical College, Mangalore on 5-6 December, 2015. The theme of the conference is 'Innovations and Updates in Hospital Management'.

There is increasing pressure on hospitals to achieve financial sustainability and at the same time invest on technologies to achieve safe environment to provide care.

Innovation is increasingly being seen as the currency of the 21st century. The rapid pace with which the technological advances are taking place, it becomes essential for every hospital administrator to keep pace with it. With this premise, Academy of Hospital Administration – Mangalore Manipal chapter seeks to bring industry leaders and eminent academicians together to deliberate on these important topics at the two-day event.

The conference is being organised for doctors, hospital owners and administrators, hospital agencies, students of health administration and management, architects, civil engineers, interior designers, purchase professionals and suppliers who are interested in updating themselves with the rapidly changing healthcare industry. The conference promises to create a platform that brings together professionals of various fields involved in the healthcare arena.

One of the highlights of the conference is the CEO Conclave, where distinguished CEOs like Dr Devi Prasad Shetty of Narayana Hrudayalaya, Dr Ajay Bakshi of Manipal Health Enterprises, Dr (Brig) NK Parmar of Apollo Hospital, Dr Ajay Kumar of HCG Global will deliberate on topics ranging from impact of social medicine, retaining talent in healthcare, impact of changing technology and innovations and creating centers of excellence. This conclave will

The rapid pace with which the technological advances are taking place, it becomes essential for every hospital administrator to keep pace with it be moderated by Dr Nagendra Swamy, President, Quality Council, Manipal Health Enterprises. Other prominent speakers include Maj Gen Pawan Kapoor, Prabhu Vinayagam, Dr Supten Sarbhadhikari, Dr Nilesh Shah, Dr AK Aggarwal, Prasanna Ganapa, Dr Rajendra Patankar and Sameer Mehta.

There will be a parallel session on nursing administration where prominent nursing administrators like Dr Christopher Sudhakar and Dr Bobby Ramesh will be the speakers.

Topics that will be discussed and deliberated in the conference include Public Health & Healthcare Manage-

ment, Hospital Planning & Architecture, Hospital & Healthcare IT, Medical Equipment & Automation, Healthcare Quality & Patient Safety, Healthcare Marketing, Hospital Financing & Health Insurance, Medico Legal Issues & Patient's Rights, Healthcare Innovation and Healthcare Quality and Patient Safety. As many as 40 scientific papers and equal number of posters will be presented by the faculty and students who are coming from all over India.

Reportedly, the conference will be inaugurated on December 5, 2015 by UT Khader, Minister of Health, Government of Karnataka.

Reportedly, eminent dignitaries including Yenepoya Abdulla Kunhi, Chancellor, Yenepoya University, AJ Shetty, President, Laxmi Memorial Trust and Dr Vinod Bhat, Vice Chancellor, Manipal University and Maj Gen (Dr) RK Garg, President, AHA will grace the occasion.

Department of Hospital Administration at Yenepoya Medical College, Kasturba Medical College and AJ Institute of Medical Sciences collaborated to organise this conference in Mangalore. Dr Ghulam Jeelani Qadiri, Principal-Yenepoya Medical College is the Organizing Chairman, Dr Amitha Marla, Medical Director, AJ Institute of Medical Sciences is the Organizing Secretary and Dr Sunita Saldanha, Associate Professor, Yenepoya Medical College is the Joint Organizing Secretary. The previous editions of the conference were held in Bengaluru and New Delhi in the year 2014 and 2013 respectively.

21 INCOFYRAwill bring together traditional and modern medical systems: JPNadda st

The conference will be held from January 3-7, 2016 in Bengaluru THE 21 ST International Conference on ‘Frontiers in Yoga Research and its Applications’ (INCOFYRA) will bring together traditional and mod-

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ern medical systems, stated JP Nadda, Union Minister of Health and Family Welfare in a curtain-raiser press conference on the event. It will be

organised by the Vivekananda Yoga Anusandhana Samsthana from January 3-7, 2016, at Prashanti Kutiram, Bengaluru. Reportedly, the

conference will be inaugurated by the Prime Minister of India, Narendra Modi. The theme of the conference is ‘Yoga in Integrated Health-

care Systems’. Shripad Yesso Naik, Union Minister for State (Independent Charge) for AYUSH and Dr HR Nagendra, President of 21st INCOFYRA,

MARKET President, VYASA and Chancellor, S-VYASA University were also present on this occasion. The Health Minister stated that while we have been largely successful in addressing communicable diseases through various targeted schemes/programmes of the Ministry, non-communicable diseases (NCDs) are posing a formidable challenge.

These are lifestyle related diseases such as cardiovascular disease, diabetes, cancer, hypertension etc., which can be managed, but not cured.

He added that traditional systems of medicine such as yoga, ayurveda, unani etc, can be integrated with the mainstream medicine system to provide treatment for these NCDs. The 21 st INCOFYRA provides a platform for national and international experts and practitioners in traditional systems of medicine to present findings of evidence–based research regarding impact of yoga etc. on NCDs. It is time for making efforts for harmonious amalgamation of mainstream/ allopathy and traditional medicine system, he added. The Health Ministry is providing logistic support for research being done by the S-VYASA University in this regarding, Nadda stated.

Naik said that the conclave will be a great opportunity to bring expertise of traditional as well as modern medical science from our country and around the world on a common platform. He also said that this will also be an opportunity to learn from recent research in medical systems.

Dr Nagendra said that integration of modern medicine and AYUSH systems is the need of the hour to deal with communicable and non-communicable diseases. Modern medicine, rooted in the biomedical model with a matterbased paradigm, will offer proven solutions to most communicable diseases, to diagnose NCDs, large number of surgeries for setting right and even replacing different parts of our body as we do it in machines. The yoga therapy and other systems of AYUSH on the other hand provide not

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Integration of modern medicine and AYUSH systems is the need of the hour to deal with communicable and non-communicable diseases

just an effective treatment for NCDs but also help in prevention and promotion of positive health for well being, he added. He informed that the conference is expecting 10000 delegates from all over the world which would include medical students and professionals, AYUSH practitioners,

yoga researchers and yoga therapists and the policy makers. The main objective of this conference is to disseminate the research findings in the field of integrative medicine and give directions to future research on diabetology, oncology, cardiology, mental health etc., he added.

MARKET POST EVENT

HIM Expo and Summit held in Mumbai It brought together more than 3,000 key policy holders and decision makers all under one roof to improve the scope of healthcare construction in India

THE HOSPITAL Infrastructure & Management (HIM) Expo and Summit has established itself as a unique platform bringing together critical stakeholders in the hospital design, build and management cycle with thousands of validated industry buyers including key private and government budget holders, and investors, coming together to interact and witness latest innovations and trends from global and domestic solution providers.

Presented by Asian Paints and Draeger as gold partner, the event showcased some of the latest technologies in hospital build and design. It brought together more than 3,000 key policy holders and decision makers all under one roof to improve the scope of healthcare construction in India. Reportedly, the expo generated more than Rs 130

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crores worth business volumes for the exhibitors.

Research shows that the healthcare industry in India requires thousands of new hospitals providing more than 600,000 beds to be built in the coming years to cater to the growing needs of the Indian population. This potentially creates an opportunity of more than $25 billion for potential investors and developers and The Hospital Infra-

structure & Management Expo seeks to provide an exclusive platform for key stakeholders to congregate and address those business challenges.

The HIM Summit was inaugurated by Dr Gautam Khanna, CEO, Hinduja Hospital amid a packed out audience. The theme for day one was hospital build and design: how to conceptualise, design and build world class Indian

hospitals. Renowned international consultant Martin Fiset, Director, Fiset Hospiconsult Inc shared his unique insights on planning large format hospitals for future growth. This was followed by a session with Sandeep Shikre, CEO & President, SSA Architect who highlighted modern trends in hospital designs. The panel discussions for day one covered critical topics like the green guide: how to make hospitals think green and effective ways to contain project costs with further input from Madhulika Pise, Director, FreeSpanz.

The theme for day two of the conference revolved around Finance and Operations Management, vital organs for sustaining a healthy healthcare environment. Noted speakers included Joy Chakraborty, COO, Hinduja Hospital and Amit

Sharma, Lead Consultant, Max Institute of Health Sciences who discussed the challenges of raising capital for healthcare ventures, HR skilling in hospitals and making quality work in healthcare, facilitated by Dr Vivek Desai, Managing Director, HOSMAC. Day three of the conference focused on how technology can be used to transform the healthcare sector with Soura Bhattacharyya, Cofounder and CEO, Lattice Innovations showcasing cutting edge examples of innovative medical technology.

The challenge of imbibing healthcare IT and medical equipment within the healthcare environment was driven by moderators Suhar Gangurde, CEO, Godrej Memorial Hospital and Lakshmi Ramachandran, GM, Ortho Clinical Diagnostics.

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Reportedly, distinguished faculty from PD Hinduja Hospital, PWC, KPMG, IMS Health, NABH, JCI and AHPI as well as eminent and senior leaders from healthcare industry will share their experience and expertise on creating a sustainable future.

Contact PD Hinduja Hospital & Medical Research Centre, Mumbai Ph: +91 22 24451515 (Extension: 3204/7465), 07506423432 Email: mgmtseries@hindujahospital.com Website: www.hindujahospitalmgmtseries.com

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POISEDfor PR GRESS Telangana, the recently-formed state, is embarking on several measures to improve its health indicators BV MAHALAKSHMI

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cover )

F

rom insurance to assurance, the Telangana state government led by Chief Minister K Chandrasekhar Rao is focussing on enhancing the rural healthcare system in the newly-formed state. The one-year old Telangana government is the first state to develop a hospital-specific budget. This essentially focusses on infrastructure augmentation and decentralisation of healthcare delivery. The Telangana government has also decided to increase the planned budget from 40 per cent to 56 per cent, the erstwhile united Andhra Pradesh's allocation was 23 per cent. This move aims to take healthcare to the doorstep of the rural population.

“We believe in decentralisation of healthcare delivery in the state. At present, we have 10 districts, very soon we are planning to create more districts. Once the state forms new districts we will ensure that each district will have state-of-the-art healthcare delivery mechanism in place,” says Rao. The budget allocation costs towards hospitals’ revamp is about Rs 585 crores besides looking at mobile healthcare delivery which facilitates reach to the rural and slum population. The state government is looking at convergence of services and education as part of its improvement practices. As part of a hub-and-spoke model, the government is looking at decentralisation of medical services with 'brand Hyderabad' as a focal point.

The state government has now initiated steps to streamline the department and improve the quality of health services in government-run hospitals. “We would ensure that sufficient

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IN TELANGANA,APPROX

budget allocations are made to government hospitals,” assures Rao. Development of public health sector is crucial as nearly 85 per cent of the state's population depends on it, he adds further. “My government is determined to revamp the public health sector in Telangana and we are aware that the task is not easy. The government needs support and cooperation from all the stakeholders of healthcare,” he states.

“The Telangana government is committed to offer medical services at par with the private hospitals,” says Dr Laxma Reddy, Minister of Health, Telangana Government. "We realise that the government has to be a facilitator for moving forward as far as all healthcare initiatives are concerned. Going forward, the government will not only encourage more and more investments in the private sector, we are equally keen to ensure that our public healthcare system is also beefed up so that the rural and the downtrodden get the best healthcare facilities,” he adds.

For improving accessibility and availability of healthcare services on population basis, the state government is already drafting proposals to install one urban primary health centre for every 50,000 population and one community health centre for every two lakh population. One auxiliary nursing midwifery (ANM) is proposed for every 10,000 population, one accredited social health activist (ASHA) is proposed for every 1,000 to 2,000 slum population and one Mahila Arogya Samiti for 100150 households in the state.

As on October 2014, there are 153 corporate hospitals in the state having a total bed strength of 21,891, of which there are 5,473 Aarogyasri

1.86 crore

HEALTHCARE IN TELANGANA

OF THE TOTAL POPULATION, ARE LIVING IN

226 HOSPITALS

PEOPLE CONSTITUTING

52%

TOTAL BED STRENGTH AS ON OCTOBER 2014

TELANGANA STATE GOVERNMENT’S BUDGET ALLOCATION FOR HOSPITALS’ REVAMP

36,491

GENERALBEDS

9,124 585 8100 Rscrores AAROGYASRI BEDS

VILLAGES

beds. There are 73 government hospitals with 14,600 beds and 3,650 Aarogyasri beds. This takes the total strength to 226 hospitals comprising 36,491 general beds and 9,124 Aarogyasri beds. The trend is that Hyderabad is concentrated due to patient migration. “We see a huge migrant population from across 10 districts for treatment and surgeries.

Hence, as a first step, we decided to upgrade the existing government hospitals by inclusion of more Aarogyasri beds,” Reddy says.

“Our motto is to ensure healthcare at every doorstep in the rural areas. For this, we must ensure that the public health centres at the base level are strengthened. We need to tackle seasonal diseases like malaria, chikungunya, diarrhoea, hepatitis etc. Obviously, we require good doctors and good supply chain for medicines so that the rural population can avail the benefits. This includes upgradation of primary healthcare centres.

They should also help create awareness among people so that they can take preventive measures. Our goal is to improve rural health,” Rao informs.

Besides, in another significant step to empower citizens with convenient access to healthcare, the Telangana government has launched India’s first dedicated healthcare app for the Ministry of Health & Family Welfare, powered by Mahindra Comviva, a global leader in providing mobility solutions. The application was conceptualised by the Healthcare Innovation Cell (HIC) of the Ministry of Health. It is positioned to bring a paradigm shift in the healthcare industry by making healthcare facilities more accessible. It also reflects the government’s commitment to the Digital India Initiative.

There are more than 800 government healthcare centres comprising primary health centres, community health centres, area hospitals, district hospitals and spe-

cialised centres in the cities listed by the app. The app will help the ministry to facilitate access to its initiatives, provide public health information, locate health centres and also empower the citizens to track and record their health data through the health tools. The HIC was launched by the Ministry of Health, Medical & Family Welfare with the aim to integrate a multi-disciplinary ecosystem to share and implement relevant innovations and solutions for delivery of healthcare services. The cell actively leverages social media platforms to engage with the community and discuss healthcare innovation for Telangana.

Another initiative by the Telangana government is ‘e-arogyam’, an online e-medicine centre in all the government hospitals. The main aim of this programme is to provide quality healthcare services to poor patients in the rural areas, round the clock. These e-arogyam health centres will be linked with district hospitals

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online to provide 24-hour medical services to the people.

Thus the initiative seeks to provide timely assistance to the patients. Using this platform the doctors in the district hospitals will be connected online for suggestions and instructions to the healthcare staff in the rural primary healthcare centres (PHCs) as well as community healthcare centres (CHCs). The first e-arogyam online health centre at Jadcherla is launched on a pilot basis. Based on its success, the state government is planning to extend such online facilities to all the 10 districts in a phased manner.

Moving in the direction of better health, the compound annual rate of decline (CAD) of maternal mortality rate (MMR) in the state has been 6.4 per cent - better than the all-India average (5.7 per cent).

However, there are areas of concern. The infant mortality rate (IMR) is 41 which is the highest among the southern states, full immunisation has decreased from 67.1 per cent to 55.47 per cent.

A flashback into the status of healthcare in the Telangana region goes back to only four doctors in Khammam district in 1950s as the period was more into community-owned knowledge. Says Dr AP Ranga Rao, a veteran healthcare consultant, who moved into medical profession in 1966, affordability and access became more prevalent only when the state government increased the number of medical seats from 30 in 1951 to 2,500 currently from 14 medical colleges. “Medical education saw a lot of transition with commitment levels and business objectives, both trying to take centre-stage,” Dr Ranga Rao opines.

“There were a lot of investors making a beeline to the healthcare segment in the 1980s, which also saw a mushrooming of provider-owned private funds,” he adds. All said, local quacks still rule the roost in the remote villages as 80 per cent of them have a bet-

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Telangana has developed a hospital-specific budget that focusses on infrastructure augmentation and decentralisation of healthcare delivery

ter rapport than the unknown doctor. Is the government trying to upgrade the primary healthcare centres (PHCs), or is it a wasteful expenditure?

This is still a debatable ques-

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cover ) tion for the Telangana government which has made a lot of promises to develop the healthcare system across the spread of 10 districts.

A study done by Dr Ranga Rao says that while the costs of care are high, the first attempt by the state government should be to reduce inequity in physical access.

Attempts have been made earlier in the last decade to bridge the gap and provide universal access through different delivery mechanisms, taking advantage of modern technology. The interventions have been made cheaper, the skills of the not-for-profit private sector have been leveraged, and contemporary, widely accepted technology have been made available. The programmes initiated include Aarogyasri, 108, 104 helpline, and new training programmes to improve skills of village practitioners and certify them as community paramedics. They gained wider acceptance in the community.

Presently, the high costs of healthcare are not due to high costs of the providers but due to the intent of private sector to make enormous profits in investigations and drugs. They even indulge in malpractices like unnecessary investigations

etc. This is worsened by the attitude of government machinery which is indulging more and more in proposing and executing low priority infrastructure in healthcare to make quick money. The government could debate and discuss means and delivery mechanisms for lowering the costs of investigations and drugs.

About 22 per cent of total population i.e. 77 lakhs of the new state lives in the capital city of Hyderabad and the surrounding Ranga Reddy district. This population has access to primary, secondary and tertiary care round-theclock, at an easily accessible distance and has the required transport systems in place.

They are served by 2,400 specialists and 640 super specialists of various categories belonging to both government and the private sector, in addition to the doctors with basic qualification of MBBS. However, as Ranga Rao points out, approximately 1.86 crore people, constituting 52 per cent of the total population, are living in 8100 villages.

Access to qualified primary healthcare is beyond 5-10 km from the place they reside for 57 lakh population and it is farther than 10 km for 92 lakh

Telangana government has launched India’s first dedicated healthcare app for the MoHFW. It is positioned to bring a paradigm shift in the healthcare industry by making healthcare facilities more accessible population. They have to depend on the services of ANMs in the sub-centres for qualified care. In reality, this 1.86 crore population is dependent on local, uncertified, long-standing village practitioners of allopathic care. They stay within reach of the population and they are one of the community, accountable to the community and accept a deferred payment and payment in kind. Approximately, there is one such practitioner for every 1000 population. 80 per cent of them are matriculate.

Some of the initiatives to be taken up by the Telangana government include: ◗ Establishment of area hospitals with 100-beds covering an area of 100-125 villages by upgrading the existing hospital or new hospital. At pres-

ent, there are 54 assembly constituencies where there is a need to either upgrade the existing hospitals or create new hospitals so as to ensure that there are hospital with 100 beds in all constituencies of the state. The estimated cost of this upgradation or establishment of new area hospital is expected to be around Rs 567 crores. ◗ In order to make most of the medical services available in each district without the need for citizens to approach Hyderabad, it is proposed to create a 1,000-bed district hospital in all district headquarters, except Hyderabad, Warangal, Ranga Reddy, Nizamabad and Khammam by upgrading the district level hospitals. The estimated cost for upgrading the district

level hospitals to 1,000 beds capacity is expected to be the order of Rs 700 crores. ◗ It has been proposed to upgrade MGM Hospital, Warangal, and RIMS Adilabad to 1,000 bed hospitals. ◗ Singareni Collieries Company has been asked to set up 1,000-bed hospital at Kothagudem and another hospital in Adilabad. ◗ Upgradation of Osmania General Hospital and Gandhi Hospital to 2,000 beds has been proposed ◗ Filling up the vacant direct recruitment posts under all categories. It is proposed to create separate recruitment board for the health department. ◗ Transfers and posting play a vital role in spreading the services to urban, semi-urban and rural areas. ◗ The provisions of Clinical Establishment Act will be examined so as to collect half-yearly information from all the private hospitals on major medical service parameters such as outpatients, IP, bed strength, major surgeries done and the disease profile of the patients visiting private hospitals. bv.mahalakshmi@expressindia.com

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F O C U S : H E A LT H C A R E R E V I E W

OPINION

Lessons from Singapore

VANAM JWALA NARASIMHA RAO Chief Public Relations Officer Telangana

Vanam Jwala Narasimha Rao, Chief PRO, Telangana government, who was on a recent visit to Singapore, talks about the healthcare situation in Singapore and weighs the options of replicating the same model back in India

CONTRARY TO the Indian situation, in Singapore, 80 per cent of primary healthcare services are offered by 2000 private medical clinics; whereas the remaining is delivered by 18 government polyclinics. In India, in most of the states, specialities and super specialities in healthcare are available in private sector only while most of the primary care is done by the government. Another problem in India in general, and particularly for the middle class people is the huge costs for diagnostic services which are provided mainly by private centres.

For instance a positron emission tomography (PET) scan costs anywhere around Rs 20,000 and an magnetic resonance imaging (MRI) costs around Rs 10,000. These need to be provided by the government at affordable costs. It is also desirable that the government establishes its own polyclinics and also takes the help of private clinics to enabe the patients to get treatment at affordable costs.

It is high time that we study systems elsewhere and adopt them here. For example, Singapore’s healthcare delivery system provides its populace with primary healthcare, hospital care, long-term care and other integrated care. The city state has a network of outpatient polyclinics and private medical practitioners’ clinics to provide primary medical treatments, preventive healthcare as well as

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Approximately 70-80 per cent of Singaporeans obtain their medical care within the public health

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The government's healthcare system is based upon the ‘3M’framework.

Medifund, Medisave, Medishield

health education. In Singapore, hospital care consists of inpatient, outpatient, diagnostic and emergency services. In contrast to primary healthcare, public hospitals provide 80 per cent of hospital care including speciality treatment.

Even in the bed strength, government hospitals account for 80 per cent, whereas private hospitals the remaining 20 per cent. The percentage of registered doctors (excluding specialists) and in the public institutions is about 80 and that of private sector is a mere 20. The early primary healthcare in Singapore commenced with a government promoted National Health Plan in 1983. The plan is being updated from time to time to suit the needs of people.

There are three main regulators in the system, Minister of Health (MOH), Central Provident Fund (CPF) and Monetary Authority of Singapore (MAS). MOH oversees the provision and regulation of healthcare services. CPF is a comprehensive and compulsory social security savings plan. It ensures working Singaporeans and permanent residents (PRs) to support themselves in the old age.

MAS, as Singapore’s central bank, regulate the financial aspect of insurance sector.

Insurance department of MAS administers the Insurance Act, which protects the interests of policyholders.

The well-established healthcare system in Singapore consists of 13 private

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cover ) In Singapore,

80

The Emergency Department at SGH is one of the busiest in the country

%

of primary healthcare services are offered by

2000 private medical clinics

At SGH, patients have access to over

600 29 doctors from

clinical specialities

hospitals, 10 government hospitals and a number of specialist clinics, each one specialising in catering to the needs of different patients at varying costs. Patients are free to choose the providers within the government or private healthcare delivery system and can walk in for a consultation at any private clinic or any government polyclinic.

Both the private and public hospitals of Singapore are equipped with state-of-the-art medical equipment in order to maintain the highest standards of medical services.

The government's healthcare system is based upon the '3M' framework. This has three components: Medifund, which provides a safety net for those not able to otherwise afford healthcare, Medisave, a compulsory health savings

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Singapore government ensures affordability of healthcare within the public health system, largely through a system of compulsory savings, subsidies and price controls.The Singapore General Hospital (SGH) is the largest and oldest public hospital in Singapore

scheme covering about 85 per cent of the population, and Medishield, a governmentfunded health insurance scheme. Singapore government ensures affordability of healthcare within the public health system, largely through a system of compulsory savings, subsidies and price controls. Singapore's

system uses a combination of compulsory savings from payroll deductions to provide subsidies within a nationalised health insurance plan known as Medisave. Medisave was introduced in April 1984 which allows Singaporeans to put aside part of their income into a Medisave account to meet future personal or im-

mediate family's hospitalisation, day surgery and for certain outpatient expenses. Under this system, Singaporean employees contribute 6.5 to nine per cent (depending on age group) of their monthly salaries to a personal Medisave account. The savings can be withdrawn to pay the hospital bills of the account

holder and immediate family members.

A key principle of Singapore's National Health Scheme is that no medical service is provided free of charge, regardless of the level of subsidy, even within the public healthcare system. At the same time no one is refused treatment on the pretext that payment has not been made. Normally, the charges are collected at the time of discharge and irrespective of bill paid or not the patient is discharged first.

There is a mechanism to chase the defaulters. Approximately 70-80 per cent of Singaporeans obtain their medical care within the public health.

The Singapore General Hospital (SGH) is the largest and oldest public hospital in

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F O C U S : H E A LT H C A R E R E V I E W

A key principle of Singapore’s National Health Scheme is that no medical service is provided free of charge Singapore, of which the foundation of its first building was laid in 1821.

The Tan Tock Seng Hospital is the second largest hospital, but, its accident and emergency department is the busiest in the country largely due to its geographically centralised location. SingHealth is Singapore's largest group of healthcare institutions. At SGH, patients have access to over 600 doctors from 29 clinical specialities. Its dedicated team of healthcare professionals is committed to give each patient the quality of care that would best address the clinical problem. Except for emergency cases, patients are admitted to SGH only on recommendation from their medical specialists from the Specialist Outpatient Clinic. Once a date for admission is confirmed, patients are encouraged to visit the hospital’s pre admission testing (PAT) centre to seek information on ward accommodation and register themselves for their desired accommodation class. The PAT Centre will also schedule appointments for patients to undergo compulsory pre admission investigations such as blood tests, chest X-ray, electrocardiogram, which are conducted one week before admission.

The Emergency Department at SGH is one of the busiest in the country. There is a senior emergency physician on duty on every shift. Patient will be assigned a specific priority level according to the severity of his or her medical condition.

Emergency Ambulance Service (EAS) is operated by the Singapore Civil Defense Force (SCDF) and it can be reached by dialling 995. The service is designed to provide an immediate response to patients with life-threatening situations. EAS is meant for calling during medical emergencies only. One may dial 1777 instead, if an ambulance is required, for non-emergency condition. The SCDF operates a 24-hour emergency ambulance service (EAS), which is ready to answer to any emergency at any part of Singapore. Qualified medical personnel, who are equipped to handle emergencies, man all the ambulances. However, if a case attended to by the SCDF is deemed to be a non-emergency by its paramedics, the patient will have to pay an ambulance fee of $180. Probably, it would be a good idea if the system in Singapore is applied to Indian situation and conditions.

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KNOWLEDGE I N T E R V I E W

Till date, 25230 TB patients notified in MP TB has been listed as a notifiable disease by the Union Ministry of Health since May 2012.

Dr Atul Kharate, State Tuberculosis Officer, Madhya Pradesh and Directorate of Health Services, Madhya Pradesh, talks about the impact of the move, other measures undertaken in the state to curb TB incidence and more, in an interaction with Usha Sharma In May 2012, the Union Ministry of Health listed tuberculosis (TB) as a ‘notifiable’ disease? How has the move helped?

The involvement of the private sector has increased. More and more private practitioners are getting sensitised about the standards of TB care in India.

Sensitisation of private practitioners was done with the help of Indian Medical Association (IMA). Private practitioners have started referring patients to the nearest government health facilities for diagnosis and treatment facilities. So far, 2949 private practitioners are registered under NIKSHAY (a webenabled and case-based monitoring application to monitor Revised National Tuberculosis Programme effectively) So far, how many TB cases has been reported in the state? How many of them are covered under the Directly Observed Treatment, Short Course (DOTS) programme?

A total of 25230 TB patients have been notified till date (from May 2015). Out of the

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8948 patients notified from private sectors, 3598 of them have been put on the DOTS programme (since April 2015).

What are the initiatives undertaken in the state to eradicate TB? The state decentralised TB diagnosis and treatment services including drug resistant (DR) TB. LED microscopes are provided to all districts. In addition to this, 22 NGOs are involved in the programme under different partnership options. State-level training for DOTS officials and NGOs on partnership guidelines were also organised to identify district-wise needs for involvement of these NGOs in the programme.

Often patients do not complete their treatment course and this hinders recovery. So, how does the state educate the patients?

As soon as a patient registers for treatment, a healthcare worker (STS/ANM /MPW/TB/HV/ASHA) visits his home to confirm his

address. During this visit, the patient is counselled about completing the treatment course and the ill-effects of incomplete treatment. Patient is given directly observed treatment. So, whenever a patient misses a dose, the DOTS provider tries to retrieve that patient. There are patientprovider meetings with cured TB patients to decrease the default rate. Over a period, the state's default rate has decreased from six per cent to five per cent.

Incidence of TB has been declining since implementation of the programme, though the rate of decline is slow

Multi–drug resistant (MDR)TB is a growing concern. How many MDR cases have been registered in the state? What are the steps taken to handle these cases?

A total of 3239 MDR TB patients are registered in the state of Madhya Pradesh. The state has established seven DR TB centres. MP has six functional CBNAAT machines. It has three certified first line solid culture & drug susceptibility testing (C&DST) laboratories and one certified second line liquid C&DST laboratory. The

state also has 10 linked DR TB centres.

How will the RNTCP help in curbing TB incidence? What has been the impact of the programme?

CTD has received Rs 20 crores for the RNTCP programme management in this financial year. State health departments have good infrastructure. Central TB Division (CTD) has provided 17 new cartridge-based nucleic acid amplification testing (CBNAAT) machines to state free-of-cost under the programme. These machines will be placed at district TB centres.

Incidence of TB has been declining since the implementation of the programme, though the rate of decline is slow.

The state is focusing on strengthening the different components of the programme. It is also involving private practitioners by organising workshops.

Marginalised and vulnerable population (PL HIV, malnourished children, diabetics, tribal population) has given special consideration. u.sharma@expressindia.com

KNOWLEDGE I N T E R V I E W

‘We will likely conduct future courses in an online format’ ACCESS Health International, in collaboration with the World Bank and University of Edinburgh, recently conducted a workshop for policymakers which aimed at helping them manage markets to support public health outcomes. Siddhartha Bhattacharya, Country Director, ACCESS Health International gives more details about the course and its objectives, in an interaction with Lakshmipriya Nair

How did you hit upon the idea of starting a course for policymakers?

Many state governments feel the need to engage with the private sector to support public health outcomes. However, engaging the private sector mandates a deeper understanding of the sector, an ability to negotiate better and to manage and maintain contracts. This requires a new skill set and set of tools for policymakers to analyse and engage private markets. Thus, the need for a course that addresses this.

Elaborate on curriculum of the course? What were the considerations while designing the course? Who has been involved in its creation?

The course was developed by experts at the World Bank and the University of Edinburgh in collaboration with renowned global faculty and ACCESS Health International as India partner. The curriculum introduces a market forces framework to analyse particular markets or submarkets in the health sector.

The course talks about products and services markets and drug supply chain markets. It elucidates how markets function in various developing and Organization for Economic Co-operation and Development (OECD) countries, with specific case examples. The

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course introduces what measures governments take or can take to manage healthcare markets to improve public health outcomes. The course also details various economic, regulatory and financial policy tools that policymakers can use to manage and engage with markets.

How frequently would the course be conducted for the policymakers? What are its main objectives?

The curriculum and content is aimed at health policy practitioners working in low- and middle-income countries. It introduces participants to the Managing Markets for Health (MM4H) approach for analysing mixed domains within a health system. The course teaches participants how to formulate and test policies to steer market operation in a desirable direction that is, in a direction that contributes to sustained health and equity outcomes.

The course covers operational approaches for navigating the challenging path to harness market forces for health goals.

Participants learn about successful and unsuccessful market steering initiatives.

Participants work in groups to apply what they have learned to real world settings.

The curriculum and content aims to achieve three objectives: ◗ Introduce a framework –

The course details various economic, regulatory and financial policy tools that policymakers can use to manage and engage with the markets

comprised of market-aware analytics, external and indirect policy tools, and, consultative policy processes used to shift the operation of health markets in a desired direction; ◗ Apply the new framework and its concepts to examples from developed and developing countries’ health systems; ◗ Learn how to design health policies and support programmes, reflecting existing knowledge about how particular health markets operate and how they respond to particular policy tools.

What role does each partner play in this initiative?

University of Edinburgh and World Bank: Developed the core course and online course.

ACCESS Health: India implementation partner, local content and case study development. Garnering policymakers for the course and providing in depth technical support to the states as follow up activities for implementation of the taught concepts.

Is the course modelled on similar initiatives being conducted elsewhere in the world?

This is the first face to face policymakers course. More courses are in the planning phase, but will mostly likely be

through online teaching.

What are the unique features? How would they serve to improve the healthcare scenario?

The course offers a wider perspective to healthcare planning and execution in mixed health systems where the private sector is fairly predominant in healthcare. It helps governments move from an exclusive approach, using only the public health delivery system for achieving public health outcomes, to a more inclusive approach, using both public and private health channels to achieve better public health outcomes. Using the private network appropriately is critical, especially in resource constrained environment such as India's.

What are your learnings after conducting the course for the first time?

In the future, we need to create more contextualised case studies, build in more time for interaction among fellow policymakers and more time to discuss specific issues faced by policymakers in the states.

How will the course evolve in its future editions?

In addition to applying the learnings mentioned above, we will likely conduct future courses in an online format. lakshmipriyanair@expressindia.com

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KNOWLEDGE I N T E R V I E W

‘3D printing empowers international corporates and local businesses to unleash creativity’ Streamlining healthcare costs and increasing healthcare access are two major challenges that India faces. Rajiv Bajaj, GM India, Stratasys India explains how innovative technologies such as 3D printing is the solution to this problem, in an interaction with Raelene Kambli Excerpts....

How can 3D printing enhance surgical and treatment options for patients?

3D printing or additive manufacturing is an innovative technology that is being adopted by companies all over the world. It is used in conceptualising new ideas and testing for product functionalities, as well as for direct manufacturing of tools and end-use parts since its invention almost 30 years ago. This applies to the medical arena too as medical device manufacturers can benefit from streamlined product development cycle of surgical tools, as well as higher flexibility in innovations without design and production constraints; subsequently producing a wider variety of and more customised medical devices that cater to the needs of different patients.

In addition, application of 3D printing in pre-surgical assessments result in enhanced surgical preparedness, reduced complications and decreased operating time for surgeons and patients. For example, five-yearold Mia Gonzalez suffered from a rare heart malformation called double aortic arch, a condition in which a vascular ring wraps around either the trachea or esophagus, restricting airflow.

This required multi-faceted surgical procedures. 3D printed anatomical models (generated from CT or MRI scans) enabled surgical teams to scrutinise the actual condition of a patient and visualise the surgical solution on

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the printed model, such that the best course of action could be planned and executed seamlessly for the patient’s speedy full recovery.

What are the opportunities that 3D printing technology offers for products such as prosthetics and implants?

3D printing is changing the way prosthetics are designed and produced. Its capabilities offer a faster, more streamlined method to medical product manufacturers for developing clinical trialready devices and implants inhouse and validating form, fit and functions to manufacturability. It also enables customisation in prosthetic and implant designs with minimised cost and time, benefitting both manufacturers as well as patients. For example, engineering students of University of Central Florida (UCF) developed a customised robotic arm for six-year-old Alex Pring using a Stratasys Dimension Elite 3D Printer.

3D printing also makes it possible for medical and dental implants to replace missing teeth with pinpoint accuracy and minimum discomfort during surgical processes. Many laboratory professionals have discovered that 3D printing of dental models is faster, more economical, predictable and accurate.

The power of 3D printing lies in such instances, where users can 3D print prosthetics or implants in a matter of days instead of weeks or even longer.

One of the most recognised values of 3D printing lies in its ability to create repeatable yet customisable products without the need of mould, patterns or casting tools

Is it cost effective and how?

3D printing can help medical solutions manufacturers reduce production cost dramatically in comparison to traditional medical solutions. One brilliant example was the UCF using the Dimension 3D printer and engineering-grade thermoplastic, ABSplus, to prototype and produce end-use prosthetic arm for Alex. Traditional medical solutions would cost up to $40,000 to create one prosthetic arm and might not be able to adapt to the size of a child due to design constraints. Instead, the total cost of the materials and printing cost of Alex’s prosthetic arm cost only $350, and the robotic arm could easily be updated as the child grew by printing a new hand for approximately $20, or a new forearm for $40.

How do you see this technology scaling up?

Started over 25 years ago, 3D printing can be applied to produce parts across a wide range of industries and applications. From fully-functional medical prototypes such as knee braces for improved design efficiencies to manufacturing inflight aerospace parts, right through to high-strength automotive components that can withstand the heat and endurance of high impact functional tests, the technology and its material has advanced rapidly, finding usage across various design and manufacturing stages. The technology is not re-

stricted to a particular industry, country and continent and hence, its application is diverse.

Combined with the increase in demand for efficient manufacturing, we are convinced of the long-term growth opportunity for 3D printing in the global environment as well as in Asia.

Has India taken to the technology? What are its benefits in the Indian context?

In comparison to the global markets, India is relatively young in adopting 3D printing technology, but the market is continuously picking up speed in not just 3D printing adoption, but also education and awareness, as different sectors see the benefit that 3D printing brings to their world (e.g. to better understand abstract ideas, to create things that are impossible to create previously due to many production constraints). We see Indian hospitals using 3D printers, not just to produce anatomical models, but also various implants (skulls, jaws, to name a few) for advanced examination. Indian manufacturers are using 3D printers to produce end-use parts directly, schools are using it to prepare students for their future career where 3D printing shall play an integral part in the design and engineering spectrum. As one of the industry leaders, we are also working towards increased awareness, so that in addition to operating the 3D printers, customers can be

KNOWLEDGE empowered to innovate and maximise their investment and businesses in parallel.

Explain the technical convergence that has made 3D-printed personalised medical devices possible.

One of the most recognised values of 3D printing lies in its ability to create repeatable yet customisable products without the need of mould, patterns or casting tools – which are often the most expensive elements during the manufacturing process. Instead of extracting from blocks of materials, users send CAD designs to the software of the 3D printer, which converts the digital data into compatible format before adding layers over layers of materials to realise the designs according to pre-set coordinates.

In the US, people are using this technology at home to create missing hands, limbs,

legs etc. Can this be replicated in India?

At the moment, Stratasys focuses on the professional market where 3D printing offers solutions to companies and organisations to overcome their business challenges, including medical device research and development, surgical tools design as well as customised low-volume manufacturing of certain medical solutions such as prosthetics. Having said that, sky is the limit when it comes to innovation; and Stratasys is dedicated to serving different needs of our customers through continuous investment in 3D printing technology to push the boundaries of the industry.

Tell us about Stratasys’ market share in this segment; worldwide and in India?

Asia Pacific & Japan (APJ) has contributed significantly in recently years. The medical segment has always been a key

vertical for us and we offer a wide range of applications such as realistic anatomical models, customisable surgical tools, medical devices and components etc. There are few reports gauging the progress of the medical segment, but it has been one of the key verticals at Stratasys, alongside automotive, aerospace, education and manufacturing, as adoption rate continues to rise globally, in Asia and as well as in India.

What are your plans for India?

We have established a 3D Printing Experience Center in Bengaluru a few months back, offering total 3D experience and displaying our entire range of products and materials. It will allow the customers to see our innovative technologies in action and realise the values and growing advantages of 3D printing technology to businesses and entrepreneurs. As a trusted indus-

try leader, we recognise the importance of bringing the technology closer to where its customers are, to bridge the gap and ensure higher awareness among local population. In India, we intend to invest in identification of advanced applications (especially direct digital manufacturing system) for which our printing technologies and versatile materials are developed for.

In addition, we seek relevant niche applications where additive manufacturing can provide substantial value, and develop a comprehensive solution to address these opportunities.

Medical solutions, including surgical tools, medical devices and anatomical replicas, are definitely one of them; and we seek opportunities to promote the various applications that 3D printing can provide to the medical community in India.

What is your message to innovators who wish to

explore this technology?

3D printing empowers international corporates and local businesses to unleash creativity and streamline product development process. It addresses the inherent limitations of traditional modelling technologies through its combination of high precision and ability to produce complex geometries in relatively shorter time and lower cost, leading to vast opportunities in rapid prototyping for industries ranging from consumer goods, electronics, education, automotive and machinery as well as tooling.

While the technology has been focused on design and manufacturing applications since it was commercialised, it is beginning to show signs of broader adoption, including end-use manufacturing tools and low-volume production parts in areas such as aerospace, defense, education, healthcare, manufacturing,R&D, and automotive to name a few. raelene.kambli@expressindia.com

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KNOWLEDGE INNOVATION UPDATE

Bosch Fundus Camera: Improving eyecare Bosch Fundus Camera, a hand held device is a broad based solution offering 'anytime, anywhere' use, applicable in multiple specialties, as it is suitable for hospitals, clinics, and vision centers in settings ranging from out patient screening, in patient diagnosis and paediatric ophthalmology BOSCH INDIA’S first team to function as a start-up presented their local innovation – Bosch Fundus Camera an eye care device from Bosch- to German Chancellor Angela Merkel and Indian Prime Minister Narendra Modi during their visit to the Bosch facilities in Bengaluru recently. Referred to as the New Business Team, the target was tasked with developing world class solutions that would cater to the middle and bottom of the pyramid segments. Established in 2011 and headquartered out of Bengaluru, the team aims to develop new products but also build new business lines for Bosch in India.

Bosch Fundus Camera, a hand held device is a broad based solution offering 'anytime, anywhere' use, applicable in multiple specialties, as it is suitable for hospitals, clinics, and vision centers in settings ranging from out patient screening, in patient diagnosis and paediatric ophthalmology.

The MediBilder client software for importing, reviewing and managing images offer a telemedicine platform on the cloud for referral and offers easy integration with HMS/ HIS. It is easily integrates with existing workflows, and is HL7– and DICOM compliant PACS In terms of technical specs, the device is a non-mydriatic handheld imaging solution, offering a modular design for fundus, anterior segment and fluorescein angiogram. It has a 5 MP CMOS sensor for high quality imaging, a 40° FOV for improved sensitiv-

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abled us to get a head start.”

That said, being part of an established set-up also offers the team some advantages such as working in multiple areas which a traditional startup would not have access to. Such an approach allows the team to cross leverage its learning from different areas.

Start up, Stand-up India policy to improve technology value chain

German Chancellor Angela Merkel and Indian PM Narendra Modi with Bosch Fundus Camera

ity, an auto focus for fast capture (-11 to +3 D), a 3.5 mm dia minimum pupil size and a IR, red free, mydriatic imaging modes.

“The independence along with the agility and flexibility of a start-up team has opened up new business avenues for Bosch, and an example of that would be the eyecare device,” said Harsha Angeri, Head of Bosch India Strategy and New Businesses. “As an organisation, Bosch could add higher value to some already acknowledged business set-ups, such as the Aravind Eyecare System.

Our partnership with Aravind Eyecare System is a prime example of the impact Bosch can create while still maintaining its commercial mindset.”

Strongly driven by the philosophy that India deserves more than cheap, quick-fix solutions, the new business

team at Bosch is working towards the development and integration of smart solutions that already exist within the company’s various business domains. To that end, adopting an agile approach, like a start-up, without reinventing the wheel.

“We believe in being patriotic about the problem, but democratic about the solution,” said Angeri about the new business team’s strategy to partner with some internationally recognised technology companies to improve the solutions that are being offered in India.

Being disruptive within an organisation The areas of focus for the new business team are not the traditional businesses of Bosch. As a new entrant, so to speak, the team from Bosch is focusing on identifying ways in

which the company could disrupt incumbents. Bosch has been successful to a great extent as it has found a path to offer world class products, with respect to technology and high quality, by offering it at a price that is both affordable and competitive. A simple example of disruption being put to work was how the team leveraged an image processing technology, fundamentally used in a manufacturing line to detect cracks on automotive components, was used on the eyecare device to help detect disease in the ophthalmology space.

“By adopting a solution approach we have been able to provide world class solutions, but also deliver products at an affordable price and reduce time to market. The solutions approach to disruption has en-

The policy announced in August by the central government of India, to stimulate the spirit of entrepreneurship among the youth of India, would complement the two other key polices announced by the government Make in India and Skill India.

“We believe that the Start-up, Stand-up India policy will boost the start-up wave across the country and secure the aspiration to be seen as an innovation hub and further improve the position of the country in the global technology value chain,” said Angeri.

Previously, policies such as Special Economic Zone (SEZ) and Separate Trading of Registered Interest and Principle of Securities (STRIPs) have given a fillip to the export and IT industry, such policies could also be extended to start-ups within corporates.

“This will benefit the industry, with respect to innovation in technology and business models, without having to be bound by the policies governing the establishment it belongs to,” remarked Angeri.

IT@HEALTHCARE EXPERT SPEAK

IoT: Opening a world of possibilities for Indian healthcare NILESH MARATHE Director – Cloud Solutions, Aspect Software

Nilesh Marathe, Director – Cloud Solutions, Aspect Software discusses the benefits which can be extended to patients with the advent of Internet of Things INDIA IS facing a grave problem with just one doctor per 1,700 citizens. These statistics reflect a skewed ratio and is a cause for alarm for the Indian healthcare sector. The sector is already grappling with a host of challenges like lack of adequate equipment to diagnose, treat and monitor the progress of patients in small towns and rural villages.

But, this scenario is changing gradually with Internet of Things (IoT), a platform which facilitates real time capture of information, collating and analysis of information. This innovative technology will help resolve the Indian health industry's current challenges and ensure healthcare facilities at a lower cost to our vast population. To cater to a population spread across geographies, healthcare organisations will need to leverage mobile technology to advance access to patients and engagement through initiatives such as online scheduling, online chat, and userfriendly patient portals to name a few.

IoT is a disruptive, innovative technology which aims to radically change the way in which healthcare will be delivered, ensuring better outcomes, increasing efficiency and making healthcare affordable to all. It is expected to have a profound effect on the healthcare sector in India. The doctors will have the facility to leverage a diverse range of small but powerful wireless monitors connected through the IoT, to reach and track the patients located in distant parts of India where health-

Picture used for representational purpose

care facilities have almost been non-existent.

According to Gartner, Indian healthcare providers are likely to spend an estimated $1.2 billion on IT products and services in 2015, a seven per cent increase from the previous year.

Hospitals, clinics and ambulance services will upgrade or deploy internal services, software, data centres, IT services, devices and telecom services.

Ericsson Mobility Report and ABI Research estimates have projected that by 2019 there will be 30 billion wireless connected devices.

Future of Indian healthcare in a connected world The focus will now be on electronic health records (EHR) technology to improve the quality and efficiency of care. This technology will help to track crucial information about pa-

tients on a continuous basis at every stage of their treatment and ensure personalised care to the patients. IoT is a people-centric technology and is taking one step further to a more connected world. IoT proves to be extremely useful not only in managing health, but is also critical for disease prevention and fitness promotion. Some examples are as follows : ◗ Wearable connected devices: Patients will have a device which will help to monitor the physiological condition of the patient (such as blood pressure for hypertension patients, blood glucose levels and weight for diabetics and so on).

This periodic data can be collated with the help of IoT and will be useful to analyse the patient’s health parameters. ◗ Remote patient monitoring (RPM): This will help in keeping a track of patients in

remote places. These small, powerful wireless solutions connected through the IoT make it possible to monitor these patients instead of viceversa. These solutions will facilitate collating the patient’s data from a variety of sensors, complex algorithms to analyse it and then share it with the medical professionals who can provide correct guidance on the future treatment. ◗ Monitoring prescription drugs: Prescription drug manufacturers have already employed IoT technologies to keep the integrity of their prescriptions intact. For example, some manufacturers use RFID tags on their medication bottles. Prior to their arrival at the pharmacy, these bottles are scrutinised to make sure that they have not been meddled with. Alternately, periodic alerts may be sent to patients who have not taken their prescribed pills. ◗ Connected care: Elder care is increasingly becoming a matter of concern. IoT enabled technology will help improve the quality of life for the aged and elderly. Universally, seniors find themselves excluded from active social participation either because they are unwell or have been committed to old age homes. Through the incorporation of a range of IoT enabled systems, the elderly will be able to stay independent for longer and will be able to participate in and contribute to economic activity.

For example, the elderly will be able to perform easy tasks like checking their blood pres-

sure or weight, or mapping their respiration and heart rate rather effortlessly by means of a wearable device.

All of this suggest that we are at the dawn of an exciting revolution in patient care across India. As more things connect to the Internet and to each other, today’s tools for data management and traditional applications will fail to meet the precise analytics required for the ever-growing, massive, complex data sets known as Big Data.

This will ensure that both the consumers and healthcare professionals will benefit from wearable healthcare devices.

Cloud computing is providing Internet access to complex applications and massive computing resources, additional storage and bandwidth capacity.

There’s no arguing that investments in data and analytical tools, the network and cloud infrastructure will drastically better the quality and efficiency of India’s healthcare system. And the connected devices offer a bright future to the Indian healthcare industry.

Thus, the IoT is expected to have a profound effect on healthcare in India. It will primarily improve the access to care, increase the quality of care and most importantly cut down the cost-of-care. The healthcare ecosystem of India is moving towards an integrated healthcare delivery system that leverages technology and has the patient at its heart. In addition, it will have significant implications on the health economy in the near future with service going beyond just a phone call.

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STRATEGY MAIN STORY

CSR in Indian hospitals: Achanging panorama CSR is gaining prominence and popularity in Indian healthcare with hospitals seeking to move away from traditional notions and accept responsibility for the community as a stakeholder in corporate activity

BY M Neelam Kachhap

THE PERCEPTION of corporate social responsibility (CSR) in India is changing. It is slowly moving away from philanthropy to a process of sustainability, where the company and community have an ongoing engagement. We live in the millennium age, where boundaries mean little to the organisations turning global. Today, business is not only a profit-making proposition but also a personified image which can think, leap, rebel and emote. It is this character of business that has brought CSR to the limelight.

An offshoot of globalisation, CSR has gained immense prominence and popularity in the decision-making world.

The healthcare industry, particularly private hospitals are yet to make CSR an integral part of their business.

For the corporate hospitals in India, CSR exists more in the form of traditional philanthropy. A reflection of which can be seen in the society but the effect are not profound.

There is a need for greater visibility, education and awareness of the concept so that the hospitals can turn small efforts into larger benefits for the society.

“Corporate hospitals should be responsible and accountable in their functioning – whether it be through

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Good CSR activity retains and conserves the supply of willing and motivated staff because employees will feel the hospital is doing what is ‘right’to patients and staff.This helps the hospital run ‘by the law’and avoids political repercussions performance or interactions at every level of society. The principal philosophy of a hospital should be driven by the need to save lives, create strong preventive health mechanisms and earn trust among the stakeholders about best prac-

tices in healthcare. Social and environmental stability will follow. It cannot be the other way round,” says Jasbir Grewal, Head, Fortis Charitable Foundation and Executive VP, Fortis Healthcare.

In the last 20 years, health-

care industry in India has witnessed rapid growth and development. Multinational corporations as well as hospitals have played key roles in defining healthcare market in India and influencing the behaviour of a large number of consumers. With the explosion of information technology (IT) and medical tourism in healthcare, a new model of business and corporate governance has been created. But this new generation of hospitals have failed to capitalise on the response of the community and sustainability of the environment — the two important aspects of viability in business.

Conduction free health check-ups as a form of passive philanthropy no longer constitutes CSR. The new age corpo-

rate hospitals need to understand what CSR means.

The primary difference between CSR and traditional philanthropy is that CSR accepts the community as a stakeholder in corporate activity.

“Corporate responsibility is achieved when a hospital focusses all its practices to ensure that it operates in ways that meet, or exceeds, the ethical, legal, environmental, commercial and public expectations that society has of a healthcare institution,” says Suyash Borar, Director Xceptional Health and Wellness, Kolkata.

"The difference between CSR and traditional corporate philanthropy is that in traditional corporate philanthropy you give money to NGOs or

support causes for the poor people and in CSR you build an organisation to solve the social problem," says Dr Huzaifa Khorakiwala, CEO, Wockhardt Foundation.

“You build an internal organisation which either implements or monitors or implements and monitor both on social issues and solve the social problems. So an entire organisation is build for that and that is CSR,” he explains.

Further, the emerging perspective on CSR focuses on responsibility towards stakeholders (shareholders, employees, management, consumers and community) rather than just on maximisation of profit for shareholders. There is also more stress on long-term sustainability of business and environment and the distribution of well-being. Says Borar, “The continuous commitment by corporations towards the economic and social development of communities in which they operate amounts to CSR. This means being participative and creating independent communities and also taking care of the underprivileged.”

According to management gurus, there is an increasing recognition of the triple-bottom line: people, planet and profit, among the corporates.

The triple-bottom line stresses on the following: ◗ The stakeholders in a business are not just the company’s shareholders ◗ Sustainable development and economic sustainability ◗ Corporate profits to be analysed in conjunction with social prosperity Triple-bottom line is a very good guideline, which can be adopted to create a conducive environment for business as well as the society.

Defining CSR for hospitals Our society still has to come to terms with the idea of healthcare as a business. Corporate hospitals are viewed as profit making institution that benefit from peoples’ suffering.

Can CSR change this im-

institutional framework of laws and acceptable business practices) and to invest in human capital (by empowering and training staff).

At Wockhardt Foundation we have a partnership with government where government funds the programme and we implement it Dr Huzaifa Khorakiwala

Today’s business leaders no longer want to be loosely associated with a cause or partnership with an NGO Vishal Bali,

CEO, Wockhardt Foundation

Co-founder and Chairman of Medwell Ventures

Corporate hospitals should be responsible and accountable in their functioning – whether it be through performance or interactions at every level of society

The continuous commitment by corporations towards the economic and social development of communities in which they operate amounts to CSR

Jasbir Grewal

Suyash Borar

Head, Fortis Charitable Foundation and Executive VP, Fortis Healthcare

Director Xceptional Health and Wellness, Kolkata

age? Yes, it could if corporate hospitals understood the benefit of being socially responsible and were conscious about the interest of the key stakeholders.

However, a hospital is very different from other business and has unique operational issues.

Patients demand the best care regardless of economic justification and are more often unable to pay for it. In addition successful treatment

reduces the number of patient visits and does not try to maximise loyalty or retention, unlike business.

So, how does a hospital define its CSR with such operational challenges?

CSR in terms of corporate hospitals can be regarded as a form of capital stock renewal, reflecting the need to preserve natural capital (by minimising the hospital’s environmental pollution), to improve social capital (by supporting the

CSR: The feel good factor By incorporating CSR in their forte, hospitals can retain patients and their demand for services provided, because patients will not feel ‘scalped’.

This ensures consumer loyalty for the hospital. Further, experts opine that adopting CSR affects the entire hospital value chain and ensures public acceptability and acceptance, thus ensuring the long-term success. Good CSR activity retains and conserves the supply of willing and motivated staff because employees will feel the hospital is doing what is ‘right’ to patients and staff. This helps the hospital run ‘by the law’ and avoids political repercussions.

New breakthrough: PPP Leading corporate houses have discovered that working together with non-profit and government organisations to solve social problems can give them new insights and approaches to create business opportunities as well. Says Borar, “CSR and industry's partnership for inclusive growth are one and the same.” The new wave of CSR advocates the integration of concerns and commitments for a cause into the core competency of an organisation’s goal.

Says Vishal Bali, Cofounder and Chairman of Medwell Ventures, “Today’s business leaders no longer want to be loosely associated with a cause or partnership with an NGO. They would rather initiate cohesive working model to work with the government machinery and other variables.”

From running primary health centres to creating public awareness platform, corporate hospitals in India have many avenues to partner with the government.

“At Wockhardt Foundation

we have a partnership with government where government funds the programme and we implement it. We have worked in Tamil Nadu where we did hospital on wheels with the Tamil Nadu state government. We monitored 420 mobile medical units and we are going to start our operations with the government in Jharkhand,” reveals Dr Khorakiwala.

“Fortis foundation is collaborating with several non-profit organisations such as - the Needy Heart foundation, Aishwarya Trust, Being Human foundation, Rotary Club, and government of punjab among others, as a health partner. On an average, we conduct 80-100 congenital heart defect surgeries per month for children referred to us by our partners.

We have linkages with NGOs, government agencies and other corporate CSR foundations to carry out awareness programmes, health camps and disaster relief initiatives in case of natural calamities,” shares Grewal.

Congenital heart defects surgery is also performed at various Apollo Hospitals, Narayana Health City, Bangalore and Kokilaben Dhirubhai Ambani Hospital, Mumbai.

The way forward There is a need to develop a more rational and ethical debate on CSR. CSR should go beyond tokenism to a vital priority in healthcare of tomorrow. If hospitals expect better understanding from the community about the challenges that this sector faces it has to look at CSR. It will help improve their image and enhance the stakeholder engagement by making their performance indicators available to public in a transparent and sincere way.

CSR indeed has a strong foundation and is bound to gain momentum in the coming years. For all the attention it is now receiving, it is yet to be seen when CSR would become integral to the goal of the Indian healthcare sector. mneelam.kachhap@expressindia.com

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STRATEGY I N T E R V I E W

‘RNTCP, state programmes could benefit from adapting more patient-centric models’ Dr Kalyan Krishna Velivela, Medical Coordinator, MSF specialises in TB, especially drug resistant TB and has recently returned from Uzbekistan which is one of the many countries in Asia with a high burden of drug-resistant TB (DR-TB). In an email interview with Viveka Roychowdhury, he describes how MSF engages with public health authorities to tackle these public health issues and list some learnings which can be adapted and adopted in India Dr Kalyan, your expertise lies in clinical diagnosis and treatment of TB and drugresistant TB (DR-TB). What have been the latest advances in the techniques/ technologies to diagnose/detect TB? There are quite some advances in the initial diagnosis of MDRTB and TB in HIV patients.

These include Xpert MTB/RIF, through which initial diagnosis for TB and rifampicin (one of the key TB drugs) resistance is diagnosed rapidly (within two hours) as well as accurately. This results in immediately offering proper treatment. Xpert MTB/ RIF (also called GeneXpert) is a better diagnostic with regard to sensitivity and specificity of the test, compared to microscopy.

Other new technologies include HAIN MTBDR Plus and advance liquid based cultures using BACTEC. MSF uses these new technologies like Xpert MTB/ RIF in all its integrated TB programmes, even in resource limited settings e.g. South Sudan etc. and has tests/technologies such as BACTEC (MGIT) liquid cultures and Drug Sensitivity Tests (DSTs) in vertical programmes in Uzbekistan and Swaziland.

Are these cost effective

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enough in the quantities required to tackle the disease burden?

Xpert MTB/RIF is cost effective for diagnosis of TB as compared to others. However, at approximately $17,000 per machine, the costs for Xpert MTB/RIF are still high. Since high TB burdens and caseloads exist in resource limited countries, these costs are still higher for these countries to purchase, and implement strategies to tackle the overall burden of the disease. Although, USAID, UNITAID and Bill & Melinda Gates Foundation finalised an agreement with Cepheid to further reduce the negotiated price of the Xpert MTB/RIF test for eligible customers of the FIND country list to $9.98.1 However, given the prevalence of the disease in low and middle income countries, the cost per cartridge continues to pose a challenge in effective diagnosis and subsequent administration of treatment.

Given that TB and DR-TB has reached almost epidemic proportions in resource scarce areas, what is MSF's strategy to manage such a major public health burden?

MSF has integrated TB and DRTB components in all its projects

MSF focuses on universal access to improved and rapid TB diagnostics in all its projects and programmes

including those for Internally Displaced Persons (IDPs) and in refugee camps where the case load is high/burden is higher.

This is to ensure accurate diagnosis and treatment options within MSF projects and areas of work.

Within its vertical TB projects in Uzbekistan and Swaziland etc., MSF works in close collaboration with national authorities (national TB programmes) and other NGOs/ actors in developing and implementing different models for improved diagnostics and treatment options; models and approaches to improve adherence to available treatments; adequate infection control methods and operational research. All this is done through a patientcentred approach.

For case detection and diagnosis, MSF focuses on universal access to improved and rapid TB diagnostics in all its projects and programmes, including those for IDPs and refugee camps that MSF supports and works in.

For treatment options and strategies, in Uzbekistan, a high TB burden country with high rates of MDR-TB, MSF is piloting a nine month short course MDR-TB treatment programmes against the standard treatment regimen of 20-24

months. Enrollments are complete and all MDR-TB patients are being followed up with. The results are expected by end of 2016. This might give options for shortened treatment options, with improved adherence and better outcomes.

In addition, MSF also recognises the urgent need for shorter and better treatment regimens for MDR-TB and XDR-TB treatment using new TB drugs.

These regimens should have fewer drugs, with fewer sideeffects (better tolerated), and improved outcomes. With this aim, MSF plans to perform a clinical trial/research in some countries like Uzbekistan and Swaziland in close collaboration with the National TB programmes/ authorities.

You have served at a wide spectrum of sites, spanning Africa to Uzbekistan in primary care settings dealing with tropical diseases like kala-azar as well as the debilitating effects of malnourishment especially on materna, neonatal and child health. How do you engage with the local public health authorities to continue the work started

by MSF? In majority of our project countries (from South Sudan to

STRATEGY Uzbekistan), we always make sure to involve national programmes/Ministry of Health in whatever we do as MSF while maintaining and emphasising MSF principles, and standards of patient care and management.

For kala-azar (visceral leishmaniasis), in South Sudan, we (MSF) have been working closely with the national kalaazar programme, WHO and other key actors. This included writing diagnosis, treatment and prevention guidelines, developing strategies and supporting national programme/authorities in the implementation of the developed strategies. We were also involved in many trainings/ regional workshops to build the capacity of the national staff and Ministry of Health staff. Similar example for kala-azar can be high-lighted in Tajikistan, where we were involved in revising the national guideline; training almost more than 200 MoH staff members; providing diagnostic tests and treatments for the initial restart of the kala azar programme; identifying different actors to aid the process; and resource mobilisation for the continuity of the programme. This is a more sustainable approach.

For TB, in Uzbekistan, MSF has been working in the Karakalpakstan region since 17 years. MSF was the first international medical organisation in the country to start WHO’s DOTS plus programme and treatment of DR-TB (MDR-TB and XDR-TB). Many new approaches and strategies like ambulatory care and initiation of MDR-TB treatment with a comprehensive TB care model was developed. All this was done in close collaboration with national TB staff (doctors and nurses), National TB Programme and Ministry of Health. With this, we were able to continue our activities. Most of these new approaches and models were well accepted by national authorities, were further approved, adapted by national programme and authorities as well as rolled out further by them. Not only is this approach more sustainable but also well adaptable.

TB/DR-TB almost always coexists with HIV. What are the best strategies, from both

a clinical and public health policy point of view, to increase awareness and adherence in such cases?

To increase awareness: ◗ Effective health education strategies and health education tools should be made available; ◗ There exists an increased need to focus more on community engagement and community centric models; ◗ Of course, overall, IEC material and larger campaigns, not only to address awareness, but, to also address stigma related issues, cultural myths and beliefs, which is also crucial.

To improve adherence: ◗ As much as possible TB/DRTB and HIV diagnosis and management should be a ONE STOP SERVICE. This translated into increased integration of TB services within HIV facilities, and vice-versa. Further, these centres should be patient friendly. ◗ Effective psychosocial support, counselling should be made available to the patients. ◗ Shorter options of treatments for both the diseases will result in lower pill burden for patients and shall improve compliance to treatment. For instance, HIV treatment could benefit from fixed dose combinations (FDCs).

Similarly, shorter treatment regimens for DR-TB could be of significance in the TB landscape.

Such instances coupled with a strong clinical focus and effective management of drug side effects, and drug interactions can improve adherence.

Can you highlight some of the positive outcomes from your projects across the world ?

For TB in Uzbekistan, MSF’s pilot on nine month short course regimen (9 m SCR) is well recognised by the Central Asian region as well as WHO. With the outcomes expected by end of 2016, this might give opportunities and results to adapt the 9m SCR in other regions around the world. In addition, MSF’s comprehensive TB care model with focus on ambulatory care v/s hospitalisation is also recognised within the region, and other NGOs are planning to implement and scale it up in the region.

For kala-azar, MSF’s advocacy for Liposomal Ambisome

MSF recognises the urgent need for shorter and better treatment regimens for MDR-TB and XDR-TB treatment using new TB drugs price reduction and modified treatment regimen has resulted in better outcomes, adaptation to national programmes in eastern African countries, and also in South-East Asian countries.

Though most of your work has been out of India, what are the learnings that you feel can be adopted in India to tackle the high disease burden due to TB/DR-TB and HIV? ◗ Patient-centred models of care for TB/DR-TB facilitate individualised treatment regimens and reduce the risk of further resistance development. This works best as TB is associated with a deep seated stigma, which can only be dispelled through a sensitive approach. Hence, RNTCP or state programmes could benefit from adapting more patient centric models. ◗ Use and scale up of rapid initial diagnostic techniques like Xpert MTB/RIF, and importantly, decentralisation of Xpert MTB/ RIF or diagnostics to ensure availability in all government hospitals (or urban health centres), can facilitate rapid diagnosis of MDR-TB. This will reduce the need for patients to be referred to regional reference labs for initial diagnosis of DRTB which otherwise results in longer waiting periods, delayed treatment, as well as development of resistance (or amplification of resistance in cases which fail to respond to first line TB drugs). Earlier initiation of

appropriate treatment benefits the patients and the community curbing the spread of TB. ◗ Consider piloting other treatment options such as the nine month short course regimen for treatment of MDR-TB (the Bangladesh regimen) to assess its suitability within the Indian context. Within other contexts this has proven to be an effective approach to MDR-TB treatment which simplifies the implementation of care and subsequently access to care. Such models could be adapted in parts of the country where acceptable and possible. The shorter regimens improve compliance to treatment with improved adherence and might be cost-effective compared to standard treatment regimens that are 20-24 months in duration. ◗ Importantly, as one of the preventive measures, the implementation of policies and the application of increased regulations for the prescribing and use of WHO approved and pre-qualified TB drugs in the states and the country may be expected to impede the incidence of MDR-TB development. This needs to be followed through. ◗ Implementation of regulations aimed at preventing availability and sale of over the counter first line TB drugs; strict prescription and distribution within approved and accredited/certified centres and facilities can prevent further resistance to potent TB drugs. ◗ Development and implementation of regulations for use of some of the potent second line drugs like Levofloxacin, Moxifloacin and second line injectables is important. This is not easy; however, these drugs/antibiotics should only be used based on prescriptions, and NOT used in any patients suspected to be having TB. ◗ It is important to ensure supply mechanisms exist to prevent TB drug ruptures, and stock outs resulting in uninterrupted drug supply, through centralised stock and supply management (either at state level and/or central level).

On a personal note, dealing with disease on a daily basis, and in such resource scarce situations, when the dice

always seems loaded against your work and positive outcomes, who/what has been your inspiration to keep going?

Good team cooperation and spirit is the key in any MSF project mission or context. In addition, in my experience as a medical coordinator, better understanding of the context, culture and people mitigates a lot of challenges and enables us to move forward. I plan better; analyse all corners well before taking a chance and moving ahead.

What has been the most disheartening aspect of your role? And the most inspiring?

The most disheartening aspect of my role: In some situations, where we (as MSF) work so hard to develop and implement a programme (e.g. TB and HIV programme in one of the states in South Sudan), see it running and create a system, it is hard to absorb, and think now (after a year), when everything collapses (all the systems and structures and services) due to a man made war/violence, which is currently the situation in South Sudan.

The most inspiring aspect of my role: Working with MSF, in different contexts (stable and unstable), different programmes (epidemics/disease outbreaks, violence/war related etc.) gives me an immense opportunity to offer, learn, gain experience and exposure at both professional and personal fronts.

My role as medical coordinator is not an easy role as I am responsible for the medical component within the missionfrom planning to implementation of medical componentsalong with a multi-cultural and multi-expertise team. It is important to maintain good relations with counter parts Ministry of Health, national programmes, and other NGOs and INGOs, and actors related to medical issues.

On the other hand, with my background as a doctor and experience in tropical diseasesTB and HIV-I also play the role of a technical advisor where needed to the project/programme teams. This is a mix of technical and managerial role. viveka.r@expressindia.com

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STRATEGY OPINION

Infant nutrition: A must to steer India’s nutrition agenda

DR ARUN GUPTA Asian Regional Coordinator, International Baby Food Action Network (IBFAN)

Dr Arun Gupta, Paediatrician and Asian Regional Coordinator of International Baby Food Action Network (IBFAN), explains why it makes economic, political and development sense to make infant nutrition a central strategy to handling India's nutritional challenges

WHEN ALL is done and dusted, the Modi government’s claims to success will be judged against India’s darkest distended underbelly, its millions of malnourished children.

And, the key for the government lies in its ability to replace ad hoc actions with coordinated ones and focus on infant nutrition which will largely set the tone and tenure to the drive for ending child malnutrition.

Need for focus on infant nutrition India has more malnourished children, than any other country. The National Family Health Survey-3 (2005) found that 42.5 per cent of children under five years old were underweight and the newly released Rapid Survey on Children (RSOC) done by UNICEF and Government of India finds it coming down to little less than 30 per cent. That’s good news. But it’s bad news as well, as India stands higher than Africa as the underweight children in Africa are at 21 per cent. Let’s take the BRICS route, we stand lowest in nutrition performance !

Why focus on infancy?

It is well known, that optimal infant and young child feeding practices are crucial to prevent the child malnutrition; both under and over. Breastfeeding is ‘food’, ‘health’, and ‘care’ has it all and provides

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STRATEGY

food and nutrition security to infants and young children that has been largely ignored in fight for child malnutrition.

At the same time in India 1.2 million children die under the age of five. This means one lakh young children die every month. Among the 1.2 million under five deaths, more than 70 per cent occur during first year, and over 60 per cent deaths are due to preventable causes. According to latest analysis, 15 per cent of these are due to pneumonia and 12 per cent due to diarrhoea.

Newborn infections are another major killer too. Early breastfeeding within one hour, and exclusive breastfeeding for the first six months, good complementary feeding after six months and continued breastfeeding for two years or beyond is what WHO recommends to achieve optimal health and nutrition of children. Breastfeeding, other than providing optimum nutrition inputs during infancy and early childhood, has been shown to be number one intervention for these three major killers.

Brain develops rapidly during the initial two years, almost 80-90 per cent of it. Children who are optimally breastfed as infants have a three to seven IQ point advantage, thus implying potential educational attainment and future capabilities, productivity and earnings.

That’s why focus on infancy is critical. Not that children are vulnerable. Breastfeeding also protects children from obesity and found to reduce non-communicable diseases like diabetes, cancers, hypertension and cardiovascular disease.

Makes economic and development sense Most recent study from Brazil reveals a major economic developmental advantage that breastfed human beings have higher earning ability at 30 years related to their IQ. Raising breastfeeding rates amounts to saving huge amount of public expenditure on diarrhoea, family planning

and other illnesses. By lowering the incidence of diarrhea it could save $7.2 billion, and another $5 billion through providing protection in family panning. At the household level the cost of artificially feeding a three-month-old infant was calculated to be 43 per cent of the minimum wage of a skilled urban worker in 1999.

FACT SHEET ON BREAST FEEDING ◗ Children who are optimally breastfed as infants have a 3-7 IQ point advantage

Policy support India enacted a law in 1992 and 2003, the Infant Milk Substitutes Feeding Bottles, and Infant Foods (Regulation of Production, Supply and Distribution) Act 1992, and Amendment Act 2003. In spite of the law, baby food companies continue to aggressively promote their products, that needs to be checked to protect breastfeeding.

The 2015 report titled ‘Arrested Development’ on the findings of the fourth assessment of done by the World Breastfeeding Trends Initiative (WBTi), shows many gaps in all policy and programmes related to optimal infant feeding. Some areas that need most attention are national coordination and plan of action with budgets, Baby Friendly Hospital Initiative, Maternity Protection, implementation of the IMS Act, and infant feeding during emergencies/disasters.

Government of India claims that 80 per cent deliveries take place in health facilities, but we have only 40 per cent women initiating breastfeeding within one hour, exclusive breastfeeding nosedives to nearly 20 per cent by the time child is six months. Only about half of kids receive adequate complementary feeding and 20 per cent kids get diverse foods during six to 24-month period. This exposes kids to serious under nutrition.

In past two decades, it has not changed much. Reason is simple; we don’t invest in the interventions required to rise breastfeeding and complementary feeding rates. While one sector intervention can increase early breastfeeding within an hour, exclusive

◗ Breastfeeding also protects children from obesity and found to reduce NCDs like diabetes, cancers, hypertension and cardiovascular disease ◗ Early breastfeeding within one hour, and exclusive breastfeeding for the first six months, good complementary feeding after six months and continued breastfeeding for two years or beyond is what WHO recommends

breastfeeding requires multi sector interventions.

Need to invest It is important for governments and international agencies to invest more than what the industry does to expand its markets in order to prevent premature weaning from breastfeeding, and to address the on-going harm of current suboptimal infant feeding practices. Breastmilk and breastfeeding is economically valuable, but it is not ‘free’ and needs investment in interventions to boost it. Interventions that need investment include Baby Friendly Hospital Initiative, monitoring and implementation of the law to protect breastfeeding, training of health workers, maternity protection etc. All these need money.

Lessons can be learnt from Brazil. The evidence and the current situation make a com-

pelling case for investment in interventions to increase optimal feeding practices. Optimal infant and young child feeding, especially breastfeeding avoids waste of a valuable food resource, and strengthens a nation’s human capital. Formula feeding on the other hand increases mortality and morbidity, placing extra demands on economic resources.

What action?

Currently attention to this issue is peripheral as compared to its impact and value.

Breastfeeding is a great equaliser in providing universal healthcare. Actions that may help set in motion nutrition agenda include a national plan of action on infant and young child feeding with specific budgets. Creating a separate budget line for breastfeeding will be useful. It should be done as a priority in both relevant ministries reflected at

state level also.

PM Modi should lead a national programme for nutrition of women and children on the lines of ‘Beti Bachao, Beti Padhao’ keeping infant nutrition as a central strategy. Under the aegis of the ‘PM’s Council on India’s Nutrition Challenges’ this could be a driving force.

Last but not the least, a National Nutrition Authority may be established under the PM’s Council that would lead coordinated action on nutrition and support the states technically with its group of experts/mentors. It could become a fulcrum for a coordinated response and report to the PM’s Council, thereby reducing prevailing institutional weakness to address the problem. India does not have such an institution. On the contrary, the entire task is left to the Ministry of Women and Child Development. And, this Ministry has a very weak nutrition section in the form of a Food and Nutrition Board to deal with this. There is little coordination between the Ministry of Health and the Ministry for Women and Child Development (the nodal ministry for nutrition), let alone with other ministries such as Agriculture, Food Supplies, Labour, Trade, and Finance.

There is total lack of coordination at the level of policy and plan development.

This can strengthen governance and help change the nutrition scenario for short and long term, and as well as rapidly reduce infant mortality.

These actions would help the ruling government to achieve what was said in its manifesto, and help boost its political image; which matters more in current times. There is a pressing need to put an end to ad-hocism by giving power to such a Council to lead the policy discussions and then oversee implementation of the solutions.

Improving governance will go a long way and sustain action. Gains are too big to ignore. Can the Indian government demonstrate this leadership and will?

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STRATEGY I N T E R V I E W

‘Today, in India, CSR is starting to play a major role in areas like education and health’ Jasbir Grewal, Head, Fortis Charitable Foundation and Executive VP, Fortis Healthcare, discusses the challenges involved in implementing CSR at hospitals in India, with M Neelam Kachhap Is CSR a priority for corporate hospitals in India or is it mere tokenism?

Corporate Social Responsibility (CSR) is a priority for Fortis Hospitals. For Fortis, as an organisation, CSR has always been more than just a legal mandate – it is about corporations being socially responsible and focusing on sections of society who cannot afford quality healthcare. We have been working with the underprivileged since 2003. The Fortis Charitable Foundation was established in 2005 with the intention of supporting preventive and remedial healthcare services to vulnerable sections of society.

How would you define CSR with respect to corporate hospitals? Would you define it in terms of its stakeholders or as a form of capital stock renewal?

At Fortis Foundation, we have been working with those who cannot afford quality preventive and remedial healthcare for the past decade. The recent government mandate requires a certain minimum spending on CSR, and being accountable to its stakeholders, it is our responsibility to report all such spending in a transparent way.

What is the difference between CSR and traditional corporate philanthropy?

Traditionally, corporate philanthropy was based on a model of charity where a project continued to be dependent on the

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donation and would continue only till the donor thought necessary. The CSR mandate amounts to a huge allocation of funds towards social causes.

Today, in India, CSR is starting to play a major role in areas like education and health. The due diligence required for disbursement of CSR funds also creates certain accountability in project implementation.

According to corporate philosophy, corporates can and should discharge their social responsibility by engaging in ethical business.

However, recently there has been a lot of criticism about unethical business practices of corporate hospitals in India. Comment.

The definition of ethical business is subjective. Every corporate has a unique way of functioning. It is important that ethical generalisation that runs organisations should abide by the law of the land and help the beneficiaries on the ground.

Do you believe that CSR is a strategy for capturing and sustaining markets? Would you like to provide examples from your business?

CSR is not a strategy for capturing and sustaining markets. It is a method of ensuring that all corporates put aside a percentage of their profits for helping those who cannot afford, in our case, quality healthcare. Our healthcare initiatives do not focus on marketing our services

Our healthcare initiatives do not focus on marketing our services rather it is about using our strengths for the benefit of people, especially those who are economically vulnerable

rather it is about using our strengths for the benefit of people, especially those who are economically vulnerable.

Social and environmental stability and sustainability are two important pre-requisites for the sustainability of market in the long run. How can corporate hospitals deliver this?

Corporate hospitals should be responsible and accountable in their functioning – whether it be through performance or interactions at every level of society. The principal philosophy of a hospital should be driven by the need to save lives, create strong preventive health mechanisms and earn trust among the stakeholders about best practices in healthcare. Social and environmental stability will follow. It cannot be the other way round.

Would you agree that accountability, transparency and social and environmental investment are key aspects of CSR. Can you give examples of how this is being practiced at your organisation?

With our CSR projects, there is continuous assessment of the process and impact in terms of the project need and implementation. Our focus is healthcare for the vulnerable and hence more inclined to social impact as that is our key area. Environmental investment is more embedded in the way we operate as an organisation – the way we run all our hospitals. We abide by all the statutory pollution and environmental norms. Whether

it’s to do with recycling of medical waste, waste water filtering processes but we also conduct stringent training of all staff on how to handle and segregate waste. This is done to sustain Fortis as an environmentally sound organisation.

Are you working with non-profit and government organisations to solve social problems?

Fortis Foundation is collaborating with several non-profit organisations such as - The Needy Heart Foundation, Aishwarya Trust, Being Human Foundation, Rotary Club, and Government of Punjab among others, as a health partner. On an average, we conduct 80-100 congenital heart defect surgeries per month for children, referred to us by our partners. We have linkages with NGOs, government agencies and other corporate CSR foundations to carry out awareness programmes, health camps and disaster relief initiatives in case of natural calamities.

Has the Indian government created incentive policies as tax savings for hospitals practising CSR? The government does not offer any incentive policies as tax savings for hospitals practising CSR. Tax benefits (under 80G) are only applicable for voluntary donations to a registered organisation. mneelam.kachhap@expressindia.com

STRATEGY INSIGHT

Strong lab system: Crucial in conquering infectious diseases

JOHN LEDEK, Worldwide President - BD LifeSciences-Preanalytical Systems

John Ledek, Worldwide President - BD LifeSciences-Preanalytical Systems, highlights the importance of a fortified laboratory system for prevention and treatment of infectious diseases and better patient care IN 2011, India achieved the status of full adherence to Good Laboratory Practices (GLP) certified by the Organisation of Economic Co-operation and Development (OECD). GLP is a quality system, which has been evolved by the member countries of OECD, concerned with the organisational process and conditions under which nonclinical health and environmental safety studies on the abovesaid chemicals are planned, performed, monitored, recorded, reported and archived. This system helps to ensure the quality and integrity of safety data (on chemicals) produced by test facilities.

The need for developing a strong laboratory system is crucial to supporting prevention and treatment of infectious diseases. There are over 50,000 clinical laboratories in India and the number is increasing every year. Various studies have indicated that nearly 68 per cent of all errors in laboratory testing are associated with the pre-analytical phase - phlebotomy (blood collection) being a major component of this phase. There is immense potential to enhance the skills of laboratory technicians in line with the growing healthcare needs of the Indian population.

Clinical laboratories, like other parts of the healthcare system, are striving to provide high-quality servi ces in the face of ever-shrinking resources and increasing regulatory demands. Lab directors and managers see pre-analytical phase of laboratory testing

as a critical area for improvement that can drive not only better patient care and satisfaction, but also productivity gains and cost savings.

Quality in laboratories is very important today in this era of evidence based medicine. Quality encompasses the entire process from the time of sample collection that is preexamination or pre-analytical phase, the testing phase also known as the examination phase and the post analytical phase. The pre-examination phase is the most important in the entire testing process and this must be addressed well.

The sample collection, labelling, transport, all need to be understood well.

While quality, effectiveness and impact on outcomes con-

tinue to emerge as value-added services for the laboratories, a comprehensive quality control programme, along with preanalytical awareness and training can prove to be valuable tools to improve specimen quality and subsequently patient care.

Pre-analytical errors can contribute to costs by impacting quality of patient care (erroneous medical diagnosis, and delayed results), safety (needle-stick injuries to patients or staff), time (increased turnaround times and repeat sample collections), resources and budget (staff and equipment) and reputation (with patients and fellow colleagues).

Becton, Dickinson & Co (BD) has committed to drive high-quality practices that im-

prove patient safety in India through several initiatives. For example, BD in support with national and international labs has started the Centre of Excellence in Phlebotomy (blood collection, sampling). This landmark initiative will provide certified phlebotomy courses to healthcare professionals, laboratory technicians, assistants and nurses, and support them in driving best practices in pre-analytical processes for accurate and reliable diagnosis. BD also conducts workshops on phlebotomy based on good laboratory practices that are endorsed by the Association of Clinical Biochemists of India (ACBI), an organisation that is at the forefront of constantly improving practices in laboratory medicine.

With the bilateral support of the US Centers for Disease Control and Prevention (CDC) and Ministry of Health and Family Welfare, BD implements the Labs for Life which is a partnership project for improving quality of laboratory services, building sustainable laboratory systems, and strengthening country owned institutions within the public health sector. Technical partnerships with international agencies have enormous potential to improve health systems.

It also presents an opportunity for collaborations on common goals, with an opportunity for tapping the strengths, methodology, and resources of various expertises in the field to foster sustainability.

The Objectives of the Pro-

ject are to enhance capacity for diagnosis of communicable and non-communicable diseases in India, help in improving the quality services of identified labs from the baseline assessment by at least two additional stars/grades/levels as measured by the checklist, strengthen specimen referral mechanisms and linkages between various levels of facilities and ensure sustainability of interventions through local, state-level and country ownership.

The geographic focus for the collaborative activities will include seven states (Rajasthan, Gujarat, Maharashtra, Andhra Pradesh, Telangana, Assam and West Bengal) covering the five regions-North, West, East, North East and South. The programme will seek to identify innovative practices to support integrated laboratory services that can be leveraged across comorbidities of persons living with HIV/AIDS. BD is conducting baseline assessment that will present as a gap analysis for lab quality system strengthening efforts, identify facility-specific challenges and systemic areas of need that must be prioritised and addressed.

Patient safety in today’s scenario is a shared responsibility. Stakeholders in safe lab practices must ensure laboratories are safe because neglecting safety can be costly.

This can not only risk lives and health of patients but also jeopardise the reputation of the entire nation.

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LIFE PEOPLE

Dr H Sudarshan Ballal appointed as Chairman of Manipal Health Enterprises The move comes in line with the Group’s national and international expansion plans MANIPAL HEALTH Enterprises, one of India’s leading healthcare groups in the country, has announced the appointment of Dr H Sudarshan Ballal as its Chairman.

The move comes in line with the Group’s national and international expansion plans. Reportedly, Dr Ballal’s experience will be leveraged to reinforce the Group’s future plans in North and East over the next two years.

Dr Ballal has been part of Manipal Health Enterprises for over 20 years and has played a pivotal role in its success. In ad-

dition to being a veteran nephrologist, Dr Ballal is also the Chairman of the Medical Advisory Board and Medical Director, Board of Director & Member of Management Committee of MHEPL and a Senate Member of Manipal University.

He has also held several other portfolios internationally such as the Adjunct Professor of Medicine at Manipal University, a Clinical Professor of Medicine at St Louis University Medical Centre, Chairman of the Board at Stempeutics Research, teacher/examiner in DNB Nephrology and exam-

iner for the Royal College of Physicians (RCP), London.

Commenting on the recent appointment, Dr Ranjan Pai, Director, Manipal Health Enterprises said, “I am confident that under his astute leadership and guidance in this additional role as Chairman of Manipal Health Enterprises, the company will go a long way in making our healthcare business achieve and succeed in its goals and vision. While thanking Dr Ballal for his value additions so far, I wish him all the best for his new role.”

Dr Ballal is also member of many professional societies and a recipient of various awards including the Rajyotsava Award bestowed by the Government of Karnataka.

Philips India appoints VRaja as Vice Chairman and MD Raja will be responsible for driving and building the healthcare and consumer lifestyle businesses for Philips in India PHILIPS INDIA has appointed V Raja as the ViceChairman and MD for Philips India, effective from December 1, 2015. Reportedly, in his new role, Raja will be responsible for driving and building the healthcare and consumer lifestyle businesses for Philips in India.

Raja takes over from A Krishna Kumar, who moved to a new role effective September 1, 2015 as Head of the Emerging Businesses Group for Philips globally and is based in Netherlands.

Raja’s experience spans over three decades across diverse industries including healthcare, consumer products and food, in leadership

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roles in finance, business development, and procurement.

He joins from TE Connectivity, where he was the President of India Operations since 2011.

Prior to TE Connectivity, Raja worked with GE for 14 years of which seven years as Business leader of GE Healthcare South Asia and has a proven track record of delivering strong growth and profitability, and nurturing and growing talent.

“We are pleased with the appointment of V Raja and we are confident that Philips will greatly benefit from Raja’s leadership and rich experience in business to consumer and business to business industries. Based upon the solid foundation that was estab-

lished under Krishna’s leadership, Raja will play a key role in further strengthening our position in the Indian market as the leading company in health and well-being,” said Ronald de Jong, Chief Market Leader, Royal Philips.

Commenting on his role at Philips India, Raja said, “I am excited to work with Philips, the company that has been innovating consistently to cater to the needs of modern day customers while maintaining the technological lead that lies at its core since its inception. It will definitely be an enriching experience to be part of a team that is changing the way India defines healthy living.”

LIFE HOT SEAT

DR SURESH ADVANI

An unshackled soul N

Leading oncologist, Dr Suresh Advani's life is an awe-inspiring saga of struggle and subsequent triumph of human spirit over destiny

BY LAKSHMIPRIYA NAIRt

ovember 17, 2015; 8:45 pm. Waiting at Jaslok Hospital, Mumbai, I rue the need to work on a Friday night and wish myself elsewhere, enjoying the beginning of my weekend. Yet, fifteen minutes later, I met a remarkable person who has left an indelible mark on my psyche - Dr Suresh Advani, Director, Department of Medical Oncology, Jaslok Hospital & Research Centre. The 68-year old renowned oncologist and pioneer of bone marrow transplant in India has faced several trials by fire. But, he has emerged from them stronger and unbowed, if not unscathed.

Overcoming all odds The journey that has made him what he is today often resembles a bumpy, roller-coaster ride filled with several ups

and downs. Born on August 1, 1947 in Karachi, Sindh, mere fifteen days before India gained independence, the first upheaval in his life was caused by the Partition. His family had to leave behind their land and relocate. Eight years later, fate dealt him another unkind blow; he was struck by polio, a debilitating disease. In the 50s, polio vaccine wasn't available in India and its treatment wasn't all that developed. As a result, it left him wheelchair bound. Yet, the three months when he underwent frequent treatment at the hospital for his ailment also gave him an insight on a doctor's pivotal role in the society and a respect for the medical profession.

Undeterred and undaunted by his handicap, he dreamt of being a doctor himself and improving people's life through his work.

But the higher powers were in no mood to make it easy for him. He encountered a major hurdle when after complet-

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LIFE ing his intermediates with good grades from KJ Somaiya College; he decided to pursue his ambition and opted for MBBS. He recollects how Grant Medical College, one of the four major medical colleges in Mumbai at that time, denied him admission due to his handicap. A lesser person might have given up on his goal and accepted the setback as his fate, but Dr Advani was made of sterner stuff.

He refused to take this rejection lying down and wrote to the Mumbai University Chancellor and the government against what he saw as injustice. Finally, a letter from the state's health minister caused the authorities at the Grant Medical College to relent and gained him a medical seat.

Thus, his perseverance and determination paid off.

Embracing oncology Despite the initial unpleasantness, Dr Advani has very fond memories of his days as a medical student at the Grant Medical College. He remains grateful to his friends and teachers who took him to their hearts.

After completing his MD in General Medicine, he took up oncology, though in those days it wasn't a ‘popular' choice among medical students. He began his career from Tata Memorial Hospital (TMH) in 1974 as an Assistant Medical Oncologist and went on to become the Professor and Chief, Department of Medical Oncology, in his thirtyyear stint at the hospital.

Spearheading progress During the early phase of his career at TMH, haemetology caught his interest and his research on leukaemia took him to places like the US, the UK and Japan in pursuit of improved methods to treat the disease. He has some prestigious fellowships to his credit such as the International Cancer Research Technology Transfer (ICRETT) and Fellowship of YamagiwaYoshida Memorial International Cancer Study Grant by the International Union Against Cancer (UICC). He also visited the Fred Hutchinson Cancer Research Centre, Seattle, Washington, US for four weeks to

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gain experience on bone marrow transplantation and medical oncology.

After returning to India with his new-found knowledge, he successfully led the first bone marrow transplant in the country. Bone marrow from her brother was transplanted into a nine-year-old girl down with myeloid leukaemia. He is also the Chief Investigator for the Acute Lymphoblastic Leukemia Project supported by the National Cancer Institute, Washington and the Chronic Lymphatic Leukemia Project supported by the Department of Science and Technology.

joys immensely. We learn as we teach," he says. He is a recognised M Sc and PhD Guide in Applied Biology. He also trains young oncologists and imparts his knowledge to them. But, the most vital message he wants to pass on to the new lot of doctors is, “We are there because our patients are there. So, take time to listen to their issues, clarify things to them and give them the much needed assurance.”

Helping hands

Witnessing a revolution In the course of his glorious career spanning over four decades, Dr Advani has seen medical oncology transform tremendously. He informs that medical oncology as a sphere has progressed phenomenally in the last fifteen years. Recollecting how ‘knowledge was superficial and treatment drugs were few’ in those days, he informs that a person with any form of cancer did not survive beyond three years from the time of his/her diagnosis. Dr Advani regretfully informs that the first 16 patients he treated for leukaemia did not survive.

However, today, he claims that leukaemia is immensely curable. Many of his patients, especially children, have gone on to lead fulfilling lives after being treated for leukaemia successfully. "I feel great when people approach me on the road or the airport, and says that they were my patients earlier but are leading completely healthy lives now," says Dr Advani.

Speaking on the advancements in oncology, he says that for several decades, the progress in the field was quite slow. One major drug discovery or intervention happened on an average in each decade, but since the 2000s, oncology research has seen considerable headway and as a result, alongwith improved treatment rates, cost of cancer care has gone down considerably. Stating an example, he points out that earlier, in the 70s, a commonly used drug to treat cancer; ‘Vincristin'

AWARDS & ACCOLADES ◗ Padmabhushan by Government of India (2012) ◗ Dr BC Roy National Award by MCI (2005) ◗ Nazli Gad-el-Mawla Award by INCTR (2005) ◗ Lifetime Achievement in Oncology by Harvard Medical International (2005) ◗ Gifted Teacher Award by The Association of Physicians of India (2004) ◗ Dhanvantari Award (2002) ◗ Padmashri by Government of India (2002) ◗ Giant International Award (1998) ◗ Indo American Cancer Congress Inc Award of Excellence (1996)

cost Rs 400. Today, it is available for just Rs 30. He believes that technology has also played a major role in bringing about progress in the field. Treatment therapies have become targeted and effective.

In his opinion, "There has been a sea change in the way oncology is practiced. I have seen a revolution, incurable diseases have become curable."

Imparting knowledge Today, Dr Advani involvement in cancer care is varied and wide-ranging. He is a consultant at leading hospitals like Jaslok Hospital, Breach Candy Hospital, SL Raheja Hospital and others. His current research covers biological therapeutics targeting various molecular targets on the cancer cells. In the last few years, his

focus has shifted to breast cancer, another disease which is curable if diagnosed on time. He is involved in a mobile mammography project in Greater Mumbai for early diagnosis and multinational clinical trial on breast cancer. He has also played a pivotal role in establishing the medical oncology/bone marrow transplantation unit at Jaslok Hospital.

Given his expertise and in-depth knowledge in oncology it comes as no surprise that he has authored or co-authored about 648 national and international publications. Recently, he is involved in charting the syllabus along with the teaching manual for DM Medical Oncology Course, in association with Indian Medical and Paediatric Oncology Association. Dr Advani is also teacher, a job he en-

He is also a part of an NGO called Helping Hands which offers assistance to cancer patients and seeks to help them economically and deal with their psychological needs. Thus, Dr Advani is a man who has multiple things on his plate and his handicap has never managed to be a deterrent to anything that he has wanted to achieve in his life.

Incidentally, Dr Advani too has had several helping hands, people who have stood by him through his trials and successes. They include his mother, his teachers and illustrious doctors like Dr Virkar, the erstwhile Dean of JJ Hospital, Dr Sunil Parekh, Dr RD Lele, Dr VR Joshi, Dr Feroze Udwadia, etc, and last but not the least, his wife Geeta Advani, who has ensured that her husband's life remains as hassle free as possible.

Never-say-die spirit Dr Advani has proved fortune does favour the brave. His indomitable spirit, zest for life, dedication for his work and compassion has made his life’s journey an inspirational one. As I leave his office at 10 pm, I see several patients awaiting to benefit from his expertise. I had reached the tail end of my day, but his would stretch well past midnight. Walking away, lines from a poem by Robert Frost, which seems to describe Dr Advani, comes to mind: The woods are lovely, dark and deep, But I have promises to keep, And miles to go before I sleep, And miles to go before I sleep

lakshmipriya.nair@expressindia.com

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TRADE & TRENDS

Vasudev Hospitals: Quality with affordability

VASUDEV HOSPITAL, VIJAYAPUR – DIRECTORS

TARUN KATIYAR

Vasudev Hospitals Group aspires to provide world-class medical care at affordable prices with compassion and dignity VASUDEV HOSPITALS Group has concieved a concept called ‘Budgeted Hospitals’ for tier II and Tier III Indian cities.

Through this concept, it seeks to serve the society by providing quality healthcare at affordable prices.

Vasudev Hospital, Vijayapur is a 51-bedded super speciality hospital located in Vijayapur, Karnataka, offering top-notch orthopaedic and critical care services i.e. trauma and intensive care services to the residents of Vijayapur and adjoining areas.

Equipped with modern surgical facilities such as modular OT with laminar airflow, latest medical equipment complimenting the rapidly changing and growing medical field, trained medical manpower, well equipped intensive care units and pleasant aesthetics, Vasudev Hospital is amongst the premier hospitals of Vijayapur. It is centrally located in Vijayapur and is easily accessible during emergencies.

The philosophy Vasudev is another name of Lord Krishna – the god who lived his whole life for others.

The promoters of the hospita had the same notion while coining the name, ‘Vasudev Hospitals’. Human lives are impacted at the hospital. Vital decisions have to be taken in a matter of few minutes or at times, even seconds. Vasudev Hospitals’ philosophy – Living For Others – helps the decision

makers choose the best option.

Vasudev Hospitals aspire to be the most preferred healthcare provider for patients, medical practitioners and healthcare professionals by providing state-of-the-art medical care with compassion and dignity. They also aspire to increase the range of services wherever there are opportunities to meet customers’ needs and demands, on a financially feasible model.

Vasudev Hospitals Group also intend to fulfil its social responsibility through optimal use of the resources and by providing a safe therapeutic environment for all patient, staff and visitors.

Why only Vasudev hospitals? ◗ Vasudev Hospitals are focussed on selective clinical sites only. ◗ Vasudev Hospitals are not opening new hospitals; their model is acquisition of the present practice of leading healthcare professionals at the chosen location. So, Vasudev Hospitals have low operational costs and as a result higher profits. ◗ 50 per cent of their bed strength is for critical care (ICU beds), which happens to be the high healthcare requirement in the country, especially in tier II and tier III cities. ◗ Per bed cost at Vasudev Hospitals is around Rs 8 lakhs while normally it goes up to around Rs 25-30 lakhs

◗ Vasudev Hospital has the biggest ICU in Vijayapur, along with state-of-the-art modular operation theatre ◗ Vasudev Hospitals follow a protocol and policy-driven model instead of a doctordriven model, enabling them to provide quality care at affordable price.

Vasudev hospitals proud milestones ◗ Vasudev Hospitals have the distinction of treating the highest percentage of fully recovered patients with H1N1 virus (swine flu) in Vijayapur ◗ Vasudev hospitals also happen to have the highest percentage of fully recovered patients of Acute MI and Chronic IHD in Vijayapur. ◗ Vasudev Hospitals has fast become the most preferred hospital in Vijayapur, with state-of-the-art infrastructure, highly dedicated nursing care, highly qualified medical paramedical staff, and last but not the least, the most hygienic environment.

Managing Director

A

young entrepreneur with a rich experience of seven years in healthcare.Amanagement graduate in Hospital Administration,he started his first business venture called Hospaccx Healthcare Business Consulting

DR ANIRUDDHA R UMARJI

Director & HOD - Medicine

H

e is a well-known MD Physician from KMC,

Manipal/ Mangalore University.

He has been practicing in Vijayapur for the last 10 years. He is also FAGE qualified (Fellowship of Academy of General Education) from Manipal University, Manipal.

In the early stages of his career, he has worked with well-known multi specality hospitals like Bombay Hospital and Nanavati Hospital in Mumbai. He then decided to go back to his roots and serve his birthplace and started his own, well-known, critical care hospital known as the City Hospital in Vijayapur 10 years back.

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DR SHAILESH DESHPANDE

Director & HOD – Orthopaedics

Expansion plans With a mission to provide affordable healthcare to patients with their mid-sized budgeted hospitals, Vasudev Hospitals are readying themselves to serve the population of Kolhapur and Bengaluru, very soon in 2016. Vasudev Hospitals Group aims to win them over with their superior service levels and compassionate, humane touch.

Pvt Ltd six years back.

In the past six years,he has commissioned more then 90 greenfieid and brownfield projects.

He has also completed more than 170 management assignments for leading groups like Jaslok Hospital, Prince Aly Khan Medipulse,etc.to name a few.

His areas of expertise include Healthcare Consulting & Healthcare Operations,Business Diligence,Strategy Formulation, Hospital Commissioning,Process Improvement,Operations Budgeting,Redesigning & Operations Support, Commissioning Assistance, Market Survey and Feasibility Reports etc.

well-known ortho surgeon in Vijayapur, he has completed his MBBS from Karnataka University and then his D. Ortho from Rajeev Gandhi Health University. He has been practising in Vijayapur for the last 15 years. He runs his own wellknown orthopaedic hospital called - Matoshree Trauma and Fracture Hospital.

A

DR PRALHAD PATIL

Director & Medical Superintendent

well-known anaesthesiologist in Vijayapur, he had completed his MBBS from MR Medical College Gulbarga/ Gulbarga University, and his DA from JN Medical College Belgaum, Karnataka. He is also FICM (Fellowship in Intensive Care Medicine) from Apollo Hospital, Hyderabad. He has been practising in Vijayapur for the last 15 years with various hospitals.

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TRADE & TRENDS

Ansell completes 50 years of manufacturing Gammexsurgical gloves In 2014, brand GAMMEX attained the MASTER BRAND status and is a preferred choice among surgeons

ANSELL, A global leader in protection solutions, recently announced its 50th year of designing and manufacturing GAMMEX surgical gloves.

Innovation has been at the core of the brand since its inception, and that commitment will continue in the future, as evidenced by the launch of the company’s new Medical Solutions Innovation Centre in Melaka (Malaysia). In an era where rapid innovation and disruption are a constant, Ansell has achieved five decades of unparalleled expertise in providing healthcare professionals with surgical solutions that offer the comfort, safety and advanced allergy protection they demand.

GAMMEX surgical gloves were first introduced in 1965 by Harvey Ansell, the son of Ansell founder Eric Norman Ansell, who had the innovative vision of creating and packaging disposable gloves already sterilised for use via gamma radiation. Over the course of the next 50 years, new technologies, packaging, and products launched under the GAMMEX brand would keep healthcare workers protected around the world.

In India, brand GAMMEX is being marketed by JK Ansell for over 15 years now. GAMMEX surgical gloves enjoy the privilege of serving thousands of healthcare professionals across the nation every day. It is among the most preferred choice of surgeons. In 2014, brand GAMMEX attained prestigious MASTER BRAND status, which again reassures surgeon’s faith in the brand promise. The Indian market has three variants of surgical gloves from GAMMEX: ◗ GAMMEX - latex powdered surgical glove

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◗ GAMMEX PF – latex powder free surgical glove ◗ GAMMEX NON LATEX (earlier DERMAPRENE ULTRA) – neoprene surgical glove “2015 undoubtedly marks a year of achievement for Ansell and GAMMEX, but it also reminds us of the work we have ahead of us,” says Tony Lopez, President and General Manager of the Medical Global Business Unit at Ansell. “We must continue creating and innovating in order to provide OR nurses, surgeons and other healthcare workers with equipment that not only allows them to do their best work, but keeps them and their patients safe,” he adds.

In addition to breakthrough technological innovations, Ansell also looks to innovate in other ways that will benefit its end users. The company recently launched the newly designed SMART Pack for its GAMMEX gloves in EMEA. The new packaging will help with overall efficiencies – allowing doctors and nurses to easily grab and go - and is environmentally friendly. SMART Pack is scheduled to roll out globally in the coming months and will expand beyond GAMMEX into other surgical brands in the Ansell portfolio.

The new Medical Solutions Innovation Centre houses approximately 40 scientists and technicians, working in the areas of new product development, as well as product and process improvements for medical gloves. The Centre also has a state-of-the-art pilot line accessible next door that will be used to expedite new product development and commercialisation, investigate process efficiency improvements, as well as run trials to

better understand the impact of process variables on glove quality.

To culminate the 50th Anniversary global campaign,

Ansell has partnered with Direct Relief to set a goal of donating 50,000 pairs of gloves this year. Every message captured to its global eCard, will

equate to a donation of 50 pairs of gloves.

For more information, check out www.gammex50.com

TRADE & TRENDS

Cardiotrack – Portable and affordable heart healthcare Cardiotrack, a handheld ECG monitor, is easy to use, provides clinical grade output and performs predictive diagnosis to start intervention immediately IN SPITE of tremendous strides in healthcare, cardiovascular diseases continue to be one of the leading causes of death globally. Here are some recent statistics from the WHO which are extremely worrying ◗ CVD is the No. 1 cause of death globally; more people die annually from CVDs than from any other cause. ◗ An estimated 17.5 million people died from CVDs in 2012, representing 31 per cent of all global deaths ◗ Over three quarters of CVD deaths take place in low and middle income countries ◗ People with cardiovascular diseases or who are at a high cardiovascular risk (due to the presence of one or more risk factors such as hypertension, diabetes, hyper-lipedema or an already established disease) need early detection and management using counseling and

Cardiotrack can save a cardiologist's time by performing the diagnosis at the primary care level and effectively reduces the need for an invasive intervention medicines, as appropriate.

In India, especially the ratio of patients to cardiologists is an abysmal 7500:1, while the cost of an invasive procedure could be anything between $2,500 – 5,000 which roughly translates to the annual income of many people. Families on the edge of poverty are financially handicapped to meet the cost of a single intervention. This effectively ends the hopes and dreams of an entire generation.

The result can be debiliating for the family and the nation.

Every general physician in every primary healthcare centre in semi-urban and rural india can bring about a revolution in cardiovascular care if equipped with a Cardiotrack device. He/she can then check the cardiac health of every person who comes into the clinic and ensure that there is minimal chance of an incident.

A prevention methodology working on such a large scale will not just save lives. It will save families. So, what is Cardiotrack?

Cardiotrack is a handheld ECG monitor that is easy to use, provides clinical grade output and performs predictive diagnosis to start intervention immediately. This effectively reduces the need for an invasive intervention. Cardiotrack is network connected, i.e. a patient's ECG scan can be instantaneously transmitted to a cardiologists anywhere in the world. The device can save a cardiologist's time by performing the diagnosis at the primary care level.

Cardiotrack has been successfully tested at the Sri Jayadeva Institute of Cardiovascular Sciences and Research. Side by side tests were performed using Cardiotrack and the hospital's ECG machines to compare the results.

Currently, it is also being used at Chris Hospital in Kalyan Nagar, Bengaluru and at health

camps organised by the nationwide chain of clinics.

Uber Diagnostics is the company that makes Cardiotrack and it has exciting plans of revolutionising cardiovascular health. There are potential research tie-ups in the pipeline as well as increasing its reach to other countries in South Asia.

The response has been extremely encouraging as governments look to manage healthcare costs by encouraging innovation in medical technology. Cardiotrack is also looking to build up a robust ecosystem for affordable cardiac care.

Additionally, Uber Diagnostics is making a social impact by providing free ECG monitoring through heart health camps.

The ultimate goal is to have sufficient data to better understand the extent of heart health challenge in India.

AIMED launches UdaiMed for industry-academia collaborations on med devices R&D The first MoU signed between AIMED and TiMed, promoted by SreeChitraTirunal Institute for Medical Sciences & Technology ASSOCIATION OF Indian Medical Device Industry (AIMED) announced the launch of ‘UdaiMed’, a new sunrise forum for collaborative interface between user, developer, academia, industry and medical device development in India.

Reportedly, the objective of

this collaboration for academicindustry in India is to make oncampus research more aligned to medical device industry’s needs and catalyse ‘Make-inIndia’ programme.

To take forward this objective, AIMED and UdaiMed also signed its first MoU with Technology Business Incubator

(TiMed), a not-for-profit registered society promoted by SreeChitraTirunal Institute for Medical Sciences and Technology (SCTIMST), Thiruvananthapuram, for encouraging innovation and entrepreneurship in medical technologies through technology business incubation support to innova-

tors, start-ups and industry.

SreeChitraTirunal Institute was created by an Act of Indian Parliament in 1980 and SCTIMST-TiMed is financially supported by the Department of Science & Technology (DST), Government of India and the Kerala State Industrial Development Corporation

(KSIDC). Under the terms of new partnership, Shree Chitra will launch TiMeD a ‘Technology Business Incubator’ with the broad objective of supporting and facilitating innovation, entrepreneurship, start-ups, new product development specifically aimed at medical devices development and bio-

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TRADE & TRENDS materials domain.

TiMed will offer office and laboratory space with several common facilities like internet access, library, canteen, videoconferencing facilities for taking forward this collaboration.

According to Rajiv Nath, Forum Coordinator for AIMED and a signatory to the MoU between the two bodies, “The partnership between AIMED led UdaiMed and TiMed is a milestone for industry-academia partnership in the country which will foster world class practical research in India, catalysing Make-in-India mission, help reduce humungous import dependency in medical devices and bring down overall healthcare cost”.

“I am absolutely positive that the new collaboration will

The initiative seeks to foster world class relevant research in academic institutions, build up funds for research, catalyse Make-in-India mission, reduce humungous import dependency in medical devices and help bring down overall healthcare delivery cost construct a better synergy between industry needs and academic research while taking care of fund shortages for research,” added Nath.

Explaining the need for such an initiative, Nath pointed towards the ground realities of campus R&D in India stating, “R&D institutions and engineering colleges do product de-

velopment in isolation while industry has little or no idea of work being done there, and often such research have no relevance for industry. Collaboration between institutions and industry is completely absent even as most development is for peer academia acclaim rather than meeting industry’s needs or contributing to coun-

try’s competitive prowess.”

As a next step, Dr Jitender Sharma, Head of Healthcare Technology Division of NHSRC, MOH&FW (also party to this initiative) has said that “AIMED/UdaiMed could request the Government to auction all Patents which are not yet commercialised so that these can be put to use by In-

dian manufacturers for the benefit of Indian consumers and medical fraternity”.

“Monetisation of research stock will create funds for further research while helping Indian industries gain a technical lead over international competitors and reducing overall healthcare delivery cost,” pointed out Nath.

Balram Sankaran, CEO, SCTIMST-TIMED said, “Developing and commercialising medical devices is very challenging but extremely critical for competitive edge of our country. The partnership between TiMed and UdaiMed will help nurture a much needed ecosystem which can deliver great results. We are extremely delighted with this partnership.”

Tolexo: Simplifying healthcare Tolexo is India’s largest market place for business and industrial goods and brings medical supplies to the customers’ doorstep COME DECEMBER 2015, the world would be observing 'Prevention of Injuries' month. This observance for a whole month signifies the importance given, in recent times, to the availability of health related supplies.

This must have a big impact on how the medical and healthcare systems work presently in India too.

First and foremost, the Indian medical sector, unlike the other big sectors (economically), has really suffered and been neglected when it comes to public spending (a minuscule 1.3 per cent of the GDP).

The medical supply chain vertical is another sphere which calls out for desperate help.

With ever increasing risks related to vector borne diseases like malaria, kala azar and Japanese encephalitis, the demand for a robust med-

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ical supply chain has never been this vociferous. Seeking their right to a good medical supply chain, tier 1 and tier II cities has been at the fore front in making this demand, in addition to the rural towns of India, in the healthcare sector.

The medical supplies sector has its own drawbacks and restrictions. With hardly a proper mechanism or policy framework, it has been one of those unregulated sectors which is facing several bottlenecks. Hence the medical supply chain needs to adopt proper regulations and seek accountability. It has to adhere to certain regulations to ensure a quick delivery time.

Reforming the country’s medical supply chain is an urgent need as the country is facing challenges from a multitude of communicable diseases and

Navneet Rai Co founder, Tolexo

non-communicable diseases, unnatural deaths and injuries.

Tolexo seeks to do its bit to improve the medical supply chain in India So, how is Tolexo helping to fill the gap?

This supply chain deficit needs to be filled by a competent player with a wide reach over distant parts of the country, especially the local clinics in the tier II and tier III cities, as they need to get their supplies from major city hospitals, manually.

Who could be better suited for the job at hand than Tolexo, India’s largest market place for business and industrial goods.

Time and again, this B2B ecommerce company has proved its worth among others.

“We excel in this sector precisely because of our impeccable service and utmost trust worthy products that we offer,” said Navneet Rai, Co founder, Tolexo.

Taking into account the prevailing needs of the supply chain, the company has revved up its engine to give an overall boost to the existing services.

This has helped the medical sector as it helps to reduce preventable deaths due to serious injuries or during an epidemic crisis.

Tolexo has been offering a large assortment of medical equipment from 250 brands

including like Hicks, Dr Morepen, Accu-Chek and others. Its portfolio of medical equipment range from medical rehab aids to gynecology and orthopedics related supplies “The best part in this wide array of products is the fact that Tolexo has been delivering all these medical equipment with a 100 per cent trust value,” remarked Rai. Tolexo offers complete accountability on its products being genuine and their effectiveness.

The company’s supply system has made Tolexo a market leader. With a visitor base of over 1.5 million in a month, the company offers a pan-India outreach to its sellers and their products. This, in turn, helps people living in the rural and remote places to get what has eluded them up to date.

With an eye on achieving the newly pledged Sustainable Development Goals regarding healthcare, the medical suppliers have to ramp up their outreach and efficacy. This has to be in accordance with the regulations and should offer complete transparency too.

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.