Express Healthcare (Vol.10, No.4) April, 2016 by Indian Express

VOL.10 NO.4 PAGES 84

www.expresshealthcare.in APRIL 2016, `50

Sometimes Iâ&#x20AC;&#x2122;m blunt. But never pointless.

Creativeland Asia

The Indian Express. For the Indian Intelligent.

#IndianIntelligent

CONTENTS MARKET Vol 10. No 4, APRIL 2016

Chairman of the Board Viveck Goenka Sr Vice President-BPD

Neil Viegas Editor Viveka Roychowdhury* Chief of Product Harit Mohanty

SYMBIOSIS INSTITUTE OF HEALTH SCIENCES TO HOLD HEALTHCARE SEMINAR IN PUNE

ABMH ORGANISES CONFERENCE ON QUALITY IMPROVEMENT AND PATIENT SAFETY

8TH ANNUAL MEDICO LEGAL REVIEW CONCLUDES IN MUMBAI

GLOBAL COALITION AGAINST TB ORGANISES MP ROUNDTABLE MEET

BUREAUS Mumbai Sachin Jagdale, Usha Sharma, Raelene Kambli, Lakshmipriya Nair, Sanjiv Das Bengaluru Assistant Editor Neelam M Kachhap DESIGN National Design Editor Bivash Barua Asst. Art Director Pravin Temble Senior Graphic Designer Rushikesh Konka Senior Designer Rekha Bisht

PAVING WAYFOR APUBLIC HEALTH REVOLUTION IN INDIA The first edition of Healthcare Sabha saw an interdisciplinary group of professionals working in public healthcare deliberate, discuss and debate on cohesive, unified and innovative ways to achieve ‘Universal Access to Equitable,Affordable and Quality Healthcare Services.’Glimpses of the event ...| P20

Artists Vivek Chitrakar, Rakesh Sharma Photo Editor

INTERVIEWS

STRATEGY

EXPERT SPEAK

Sandeep Patil MARKETING Regional Heads Prabhas Jha - North Harit Mohanty - East & West Marketing Team Douglas Menezes

P12: SUSHANT KINRA MD, Carestream Health India

P48: DR ALEXANDER

Ambuj Kumar

THOMAS

E.Mujahid

Chairman, HSSC, Karnataka

CAN COMMUNITY OWNED MUTUAL MICRO INSURANCE PROVIDE HEALTHCARE FOR ALL?

TAXING TOBACCO PRODUCTS INDIA: A PUBLIC HEALTH VIRTUE

HEALTH IS TRULY WEALTH

Arun J Debnarayan Dutta

P52: COL KANWAR BADAM

Ajanta Sengupta

VSM - Head, Piramal Swasthya Foundation

PRODUCTION General Manager

BR Tipnis Manager Bhadresh Valia Scheduling & Coordination

P54: SWAPNEEL NAGARKAR Senior Vice President Marketing & Sales (B2B), Godrej Interio

Ashish Anchan CIRCULATION Circulation Team Mohan Varadkar

P57: VIVEK SINGH Technical Architect, ThoughtWorks

Express Healthcare® Regd.with RNI no. MAHENG/2007/22045,Postal Regd. No. MCS/162/2016 – 18,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 © 2016 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.

QUOTE UNQUOTE

MARCH 2016

We are providing free treatment, medicines and diagnostic facilities. You can avail these facilities for minor ailments.You do not need to go to a private doctor anymore Check out the online version of our magazine at

www.expresshealthcare.in

HEAD OFFICE Express Healthcare® MUMBAI Douglas Menezes The Indian Express (P) Ltd. Business Publication Division 2nd Floor, Express Tower, Nariman Point Mumbai- 400 021 Board line: 022- 67440000 Ext. 502 Mobile: +91 9821580403 Email Id: douglas.menezes@expressindia.com Branch Offices NEW DELHI Ambuj Kumar The Indian Express (P) Ltd. Business Publication Division Express Building, B-1/B Sector 10 Noida 201 301 Dist.Gautam Budh nagar (U.P.) India. Board line: 0120-6651500. Mobile: +91 9999070900 Fax: 0120-4367933 Email id: ambuj.kumar@expressindia.com Our Associate: Dinesh Sharma Mobile: 09810264368 E-mail: 4pdesigno@gmail.com

EXPRESS HEALTHCARE

April 2016

Arvind Kejriwal Chief Minister, Delhi (At the launch of 21 Mohalla clinics in different parts of the country’s capital)

CHENNAI Arun J The Indian Express (P) Ltd. Business Publication Division 8th Floor, East Wing, Sreyas Chamiers Towers New No 37/26 (Old No.23 & 24/26) Chamiers Road, Teynampet Chennai - 600 018 Telephone (Board): +91 44 24313031/32/34 Fax: +91 44 24313035 Mob: +91 9940058412 Email id: arun.j@expressindia.com BENGALURU Amit Tiwari The Indian Express (P) Ltd. Business Publication Division 502, 5th Floor, Devatha Plaza, Residency road, Bangalore- 560025 Board line: 080- 49681100 Fax: 080- 22231925 Email id: amit.tiwari@expressindia.com HYDERABAD E.Mujahid The Indian Express (P) Ltd. Business Publication Division 6-3-885/7/B, Ground Floor, VV Mansion, Somaji Guda, Hyderabad – 500 082

Board line- 040- 66631457/ 23418673 Mobile: +91 9849039936 Fax: 040 23418675 Email Id: e.mujahid@expressindia.com KOLKATA Ajanta Sengupta The Indian Express (P) Ltd. Business Publication Division JL No. 29&30, NH-6, Mouza- Prasastha & Ankurhati, Vill & PO- Ankurhati P.S.- Domjur (Nr. Ankurhati Check Bus Stop) Dist. Howrah- 711 409 Mobile: +91 9831182580 Email id: ajanta.sengupta@expressindia.com KOCHI Arun J The Indian Express (P) Ltd. Ground Floor, Sankoorikal Building, Kaloor – Kadavanthra Road Kaloor, Kochi – 682 017 Mobile: +91 9940058412 Email id: arun.j@expressindia.com COIMBATORE Arun J The Indian Express (P) Ltd. No. 205-B, 2nd Floor, Vivekanand Road,

The Government understands the significance of improving the delivery of public health provisions including vaccination, family planning and maternal health outcomes, in promoting all-round growth and development of women and children, who are the bedrock of a healthy nation Jagat Prakash Nadda Union Minister for Health and Family Welfare. Government of India

Opp. Rajarathinam Hospital Ram Nagar Coimbatore- 641 009 Email id: arun.j@expressindia.com AHMEDABAD Nirav Mistry The Indian Express (P) Ltd. 3rd Floor, Sambhav House, Near Judges Bunglows, Bodakdev, Ahmedabad - 380 015 Mobile: +91 9586424033 Email Id: nirav.mistry@expressindia.com BHOPAL Ambuj Kumar The Indian Express (P) Ltd. F-102, Inner Court Apartment, 1st Floor, GTB Complex, Behind 45 Bungalows, Bhopal - 462 003 Mobile: +91 9999070900 Email id: ambuj.kumar@expressindia.com JAIPUR Ambuj Kumar The Indian Express (P) Ltd. S2, J-40, Shyam GHP Enclave, Krishna Marg, C-Scheme, Jaipur- 302 001 Mobile: +91 9999070900 Email id: ambuj.kumar@expressindia.com

Important: Whilst care is taken prior to acceptance of advertising copy, it is not possible to verify its contents. The Indian Express (P) Ltd., cannot be held responsible for such contents, nor for any loss or damages incurred as a result of transactions with companies, associations or individuals advertising in its newspapers or publications. We therefore recommend that readers make necessary inquiries before sending any monies or entering into any agreements with advertisers or otherwise acting on an advertisement in any manner whatsoever.

FEEDBACK ON HEALTHCARE SABHA 2016 A GREAT LEARNING EXPERIENCE

irst of all congratulations for the grand success of Express Healthcare Sabha. It was a very well thought event and a great learning experience. Gaurav Chaudhary, SPAG Asia

A WONDERFUL SHOW!

ongrats to Indian Express Team for the Success of Healthcare Sabha 2016. The entire team deserves appreciation for the hospitality and support. It was a wonderful show, excellent co-ordination, a platform for discussing vari-

ous healthcare issues with the best in the sector. Though we were able to discuss and share thoughts with most during the event, we need to keep the momentum going and take it forward..

Health Policy Advocacy arena. I once again congratulate and thank the entire team at the Indian Express and wish you all the best in your future endeavours. Dr Prateek Rathi Special Executive Officer at ESI Scheme, Dept of Public Health, Maharashtra

Suresh Babu PM Deputy GM (Marketing) HLL Lifecare

A THOUGHT PROVOKING EVENT

INSIGHTFUL AND ENJOYABLE

t the outset let me congratulate for taking this initiative and starting this wonderful event of Healthcare Sabha! It was indeed my pleasure to be part of the event and my privilege to be in some august and distinguished company. My sincere thanks to the entire team for making

the stay of the participants very comfortable. As India takes up the challenge of moving from MDGs to SDGs; health being one of the important and critical component of the same, I think such conclaves can

provide thought provoking insights and course correction in the process. I am sure as we go forward, the Healthcare Sabha will evolve, especially in regards to its content and theme and will play a crucial and meaningful role in the

he conference was not only enjoyable but gave me lot of insights. Thank you for all the coordination and comfort. It was a fruitful and enjoyable event. Avinash Supe Director and Dean, GS Medical College & KEM Hospital

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April 2016

EDITOR’S NOTE

Healing public healthcare

nion Minister of Health and Family Welfare JP Nadda's recent statement that "devolution, decentralisation and timely responsiveness would be the focus of the National Health Mission (NHM)" is a continuation of the move to strengthen the existing framework. Need-based approvals of state wise proposals were the underlying principles of the National Rural Health Mission (NRHM) when it was launched. They form the basis for the National Urban Health Mission (NUHM) as well. Both of these sub missions now come under the overarching NHM. The statement was made at the third meeting of NHM’s Mission Steering Group. Clearly, this move is "to enhance the reach and effectiveness of the health programmes under the NHM." Even though the Union Minister went on to list the not inconsiderable achievements of his Ministry, there is always room for improvement and modifications based on a review of past performance, as well as evolving disease and demographic profiles. It is certainly good news that state health administrations will be further strengthened as they are the best judge of which schemes will offer greater benefits. More importantly, with this stated focus, state health authorities would be better equipped to respond more quickly and effectively to health related emergencies like epidemics as well as natural calamities like earthquakes, floods, droughts etc. These leave a lingering disease burden and take a long term toll on the health indices of resident and displaced populations. The MSG was also attended by Venkaiah Naidu, Union Minister of Urban Development. He underlined the role of endeavours like the Smart Cities initiative being taken by his Ministry which will impact healthy living. Hence, better co-ordination among these ministers and ministries is crucial. In fact, around the same time, the Union Health Minister also launched a GIS-enabled Health Management Information System (HMIS) application and self-printing of e-CGHS Card, which he hailed as “significant steps towards Digital India and for easy access of health services to the common man.” At present, 1.94 lakh health facilities (across all States/UTs) upload facility wise data on monthly basis on the HMIS web portal. This data is presently available to various stakeholders as standard and customised reports, fact sheets, score-cards etc. Reportedly, HMIS data is widely being used by the Ministry and States for policy

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April 2016

While all this data would be a wonderful tool for public health policymakers and researchers,to ensure evidence-based policymaking, would the private sector be game?

planning, monitoring and supervision. HMIS currently covers the public health facilities but shall soon be expanded to cover private facilities as well, according to the Union Health Minister. Will this be acceptable to corporate healthcare chains? Secondly, the application is currently available in the login domain of HMIS portal but there are plans to put it in the public domain soon, according to a PIB release. While all this data would be a wonderful tool for public health policy makers and researchers to ensure evidence-based policy making, would the private sector be game? The Health ministry is clearly moving towards an evidence-based policy formulation approach. For instance, the Longitudinal Ageing Study in India (LASI) launched on March 22, 2016, will “provide scientifically validated data on various issues of the elderly”. The data would help “provide guidance to move forward in designing schemes for the elderly”, according to BP Sharma, Secretary (HFW), who launched the study. Link this to the allocation of a special component of Rs 30,000 for the elderly in families in the recent Budget, and it is clear that the while the government will allocate funds, it will also demand data to see how these funds are being utilised. Emphasising the importance of the LASI, Dr Soumya Swaminathan, DG, ICMR said, “It will also lay the foundation for other studies on social justice issues” and “will be a strong study which will help in designing key interventions.” This is the right approach, especially if we need to stretch our existing public resources and make every rupee count. A MoH&FW offical also explained that there is a shift from a top-down, district level approach to a bottom-up, community-health approach, as evidenced by a focus on capacity building of health workers. Certain public health concerns like NCDs, TB and immunisation are likely to get more focus as well, going by the topics discussed at the MSG. All in all, it was the best time for Express Healthcare to launch its first public health focused event, Healthcare Sabha, supported by the NHM. For detailed coverage and analysis, see pages (20-43). A big thank you from the editorial team to all our dealegates, speakers and partners. Watch out for more photographs and videos which will be uploaded shortly at www.healthcaresabha.com.

VIVEKA ROYCHOWDHURY Editor viveka.r@expressindia.com

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MARKET I N T E R V I E W

‘We aspire to be an active catalyst to increase the pace of digitisation in the imaging sector’ Sushant Kinra, MD, Carestream Health India divulges his company's plans for the next fiscal, its growth strategies for the Indian market, plans to tap the prevailing opportunities in the public healthcare sector of India and more, in conversation with M Neelam Kachhap

What are your key priorities for the next fiscal? Our priorities are very clear. We have been leaders in analog for a very long time and pioneered many innovative products. This year, our vision is to be an active catalyst to increase the pace of digitisation in the imaging sector, apart from retaining and growing our market share in all product segments we offer in India. What does India contribute to your global top line? Currently, we are contributing five to six per cent of our global turnover, and by 2020, we aim to reach at least 10 per cent of it. At present, the biggest market in healthcare -the US spends 17 per cent of its total GDP, and is under severe pressure to cut down this expenditure, whereas India spends only one per cent of its total GDP on healthcare. Both these are extremes. While, the US and European markets will stagnate, and the China market is looking slow with single digit growth, the only positive outlook is India. We expect India's expenditure to go up in the near future. Thus, we foresee that the healthcare market will grow at 15-20 per cent in the next 10 years. With our innovative products and solutions, and with the favourable tail wind in India, we are confident of getting 10 per cent of our global revenue from India. What percentage of your

EXPRESS HEALTHCARE

April 2016

business comes from the public sector? Currently, the overall share of public healthcare to our total business is around 10-12 per cent. However, we see a tremendous opportunity in the public healthcare sector. Thus, we have already set up a dedicated team in India to address the needs of our public healthcare system. What are your plans to meet these goals? Adding innovative products to our portfolio is our top priority to meet these goals. We would like to position our products as a solution for productivity improvements for our customers, hence reducing the overall cost of healthcare delivery. Our innovative solutions like the X-factor in our DR detectors not only enhances the overall productivity and improves workflow but also reduces the overall cost by using single detector for multiple rooms, wireless technology and cloud-based IT solutions. What are the timelines for these product launches? This year, we would be expanding our digital radiography (DR) portfolio to address all segments of our customers, and next year we are planning to launch our ultrasound and Cone Beam CT system to capture high quality 3D diagnostic images of extremities. The ultrasound market has a

and obstetrics. We can actually partner with stakeholders to spread knowledge about ultrasound diagnosis. There are lot of innovative solutions around ultrasound which goes beyond these two modalities. This technology offers clear advantages, such as no side effects, no dosage issues, and is an affordable technology compared to high-end imaging systems.

We foresee that the healthcare market will grow at 15-20 per cent in the next 10 years unique challenge in India, the PCPNDT Act. What are your thoughts on the same? PCPNDT is a good step to prevent deliberate female foeticide and sex selection, a unique social problem in India. Though it can be seen as a major regulatory hurdle by some players in the market, we accept the significance of it. Does it limit the market growth? I don't think so. Besides, there are many more applications of ultrasound than gynaecology

What are the other challenges you face in India? Overall, I see good opportunities for healthcare in India but there are always some challenges which encourage us to use our creativity to address them. Addressing the large number of customers in public healthcare and their unique and complex requirements can be one of them. That's the main reason we now have a dedicated team for handling government business, so that we can address their needs better and engage with them to address their challenges through our innovative products and solutions. What are your investment plans for India in this fiscal? This year we have invested more in our people. We have hired more engineers, account managers and back office teams in order to serve the needs of our customers and enhance their experience. We are continuing to invest in our tools and infrastructure. We have a world class CRM system, which we plan to

integrate across all functions of the organisation. It will enable us to better identify the needs of our customers and connect with them. What is India’s share of your total expenditure? Globally, we spend about seven to eight per cent on R&D. In India, we have invested significantly on our go-tomarket strategy to ensure that we develop sustainable partnerships with our customers as well as our channel partners. There are large MNCs in the imaging space, how do you perceive this competition? We do not consider these MNCs as our competition. In fact, it's the opposite - we have excellent synergies and we are partners in all aspects of business. Are you working towards a Made in India product? We are exploring many options for our product pipeline. Take CR for example. India is the biggest market for CR systems in the world and needless to say, we are trying to look at reducing the overall cost of manufacturing them and see Make in India as an excellent opportunity to reduce these costs and enhance the pace of digitisation in India. So, there are active internal discussions happening to explore this further. I am sure something beneficial will come out of these deliberations soon. mneelam.kachhap@expressindia.com

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MARKET PRE EVENT

Symbiosis Institute of Health Sciences to hold healthcare seminar in Pune The XVIII National Seminar in Hospital & Healthcare Management, Medico Legal Systems & Clinical Research will be held on May 6-7, 2016 SYMBIOSIS INSTITUTE of Health Sciences (SIHS), a constituent of Symbiosis International University (SIU) is conducting the XVIII National Seminar in Hospital & Healthcare Management, Medico Legal Systems & Clinical Research on May 6-7, 2016 at Symbiosis International University (SIU), Lavale, Pune. Reportedly, the event has been accredited by the Maharashtra Medical Council (MMC) as well. The seminar will be inaugurated by Thumbay Moideen, Founder President, Thumbay Group, UAE. Dr Rajani Gupte, Vice Chancellor, Symbiosis In-

ternational University (SIU) and Dr Vidya Yeravdekar, Principal Director, Symbiosis will also grace the occasion. This highlights of this year's seminar will be CONNEXIONS – a workshop and placement drive, Master Classes, Star Alumnus Awards and Healer of Mankind Award. It would cover pertinent topics such as Role of Six Sigma in Healthcare, Game Changers: Telemedicine in Healthcare, Sustainable Healthcare Models, Changing Paradigm in HR, Enterprise Performance Management, Special Laws related to Healthcare etc. This year’s edition will fea-

Two awards would be given to individuals who have made commendable contributions in the field of healthcare ture four intensive, domainspecific master class sessions

as well. It will also see the introduction of two awards which would be given to individuals who have made commendable contributions in the field of healthcare and thereby to the society. The 'Healer of Mankind' award would be a lifetime achievement award while the other one will be given to a ‘Star Alumni’ of Symbiosis who has contributed significantly to the society. The valedictory ceremony is expected to be graced by renowned advocate Ram Jethmalani, Former Union Law Minister as the Guest of Honour It will presided by Dr SB Mujumdar,

Founder & President, Symbiosis and Chancellor, SIU. Thus, the XVIII National Seminar promises to be a must attend event for professionals from all verticals of healthcare.

Contact Dr Rajiv Yeravdekar Dean, Faculty of Health & Biomedical Sciences, SIU Phone: 91-020-25655023, 20255051, 08888892258, 09552588162/ 92 Email: info@schcpune.org, dep@schcpune.org, ic.symbiosis@schcpune.org, hod_academics@schcpune.org Website: www.schcpune.org

POST EVENTS

ABMH organises conference on quality improvement and patient safety Reportedly, more than 250 representatives from leading hospitals and healthcare organisations across the country participated in this conference ADITYA BIRLA Memorial Hospital recently organised the 4 th national conference ABMH QIPS-IV, 2016 on quality improvement and patient safety. It was held at Aditya Birla Memorial Hospi-

EXPRESS HEALTHCARE

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tal auditorium. The two-day conference was reportedly attended by more than 250 participants from the leading hospitals and healthcare organisations across the country.

MARKET ◗ Elements to measure safety and get satisfaction ◗ Leading quality essentials for managers ◗ Redesigning care to improve clinical outcomes ◗ Why is accreditation essential for quality and safety? ◗ Debate – does accreditation makes a difference in quality? ◗ Longer association with one

Strategies to improve the current status of quality and safety in healthcare were discussed at the event “Patient safety and providing them the best quality of healthcare has always been our objective. It is in pursuit of this endeavour that we had organised the QIPS conference for the fourth time. Like our previous conference, this year also we have received an overwhelming response. The industry stalwarts have appreciated our initiative since it serves as a good platform to come together and work towards the betterment of the society,” said Rekha Dubey, CEO, Aditya Birla Memorial Hospital. “We reviewed the current status of quality and safety in healthcare programmes in India and identified strategies to improve the same,” she further informed. The conference witnessed speakers and delegates from renowned hospitals all over India. Eminent healthcare executives mainly the CEOs, COOs, Medical Administrators, Quality Heads actively participated in the conference and discussed various aspects of quality improvement and patient safety. The two-day conference covered various topics like: ◗ Clinical Audit – Clinical Application

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April 2016

organisation (Boon or Bane?) ◗ Nursing activities to improve patient safety ◗ IT in healthcare The event also comprised paper and poster presentation on quality and patient safety. There were debates on key issues and multidisciplinary panel discussions on a few topics.

MARKET

8th Annual Medico Legal Review concludes in Mumbai Speakers discuss trends in cases of medical negligence registered against doctors and hospitals

nstitute of Medicine & Law recently organised the 8th Annual Medico Legal Review — 2016 in Mumbai. The event, supported by an educational grant from Emcure Pharmaceuticals, was attended by eminent doctors, hospital CEOs, and others discussed trends in cases of medical negligence registered against doctors/hospitals. Dr Pravin Shingare, Director, Directorate of Medical Education and Research, spoke about the grey areas in public and private healthcare sector and the problems being faced by the doctors. He spoke about the government’s action plan in identifying bogus doctors and punishing them. He also said that the government is working aggressively towards reducing the cases of medical negligence in Maharashtra. Dr Atul Shah, Ex-Secretary, Association of Plastic Surgeons of India, Director Medical Service - Solace Hospital, spoke about the medico-legal issues being raised at regular intervals in both the houses of the Parliament. He expressed concern that doctors are not well versed with medical laws and highlighted the need to create awareness amongst doctors and to update them. Mayank Kshirsagar, Advocate Supreme Court, highlighted that Punjab leads in the number of medico-legal cases followed by West Bengal and Maharashtra which is just one per cent behind West Bengal. Surprisingly, Chhattisgarh had now entered the top five states in medical litigation. He also emphasised that the courts are generally lenient towards doctors and spoke about several cases where courts have dismissed cases where doctors have acted in good faith and without any wrong intention and did their best to serve the patient. He also pointed out towards the latest trends regarding patients suing hospitals ‘only’ and not doctors. Kshirsagar

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The event, supported by an educational grant from Emcure Pharmaceuticals, was attended by eminent doctors, hospital CEOs, and others wherein several medico-legal issues were discussed also informed that the doctors are not liable for administrative lapses in case of a hospitalised patient whereas hospitals are always liable for negligence of their nurses, paramedics, employees, doctors, and anesthetists whether they are permanent or visiting,

full-time or part-time. Besides these, he also shared some important do's and dont's for doctors and hospitals and emphasised the need for ‘documentation’ and to maintain proper records. While summing up, he raised a valid point on the need for doctor ‘judges’

who would be able to better appreciate the nuances in deciding such cases. The keynote address was delivered by Mahendrakumar Bajpai-Advocate Supreme Court, and Director, Institute of Medicine and Law who highlighted some changes in deciding cases of medical negligence such as: ◗ Concept of Eggshell Skull Doctrine applied in one case. ◗ Experience of the doctor specifically taken into account by the National Commission ◗ Commercialisation of medical services taken into account. He also spoke about the right of hospitalised patients to buy medicines from any pharmacy outside the hospital. He emphasised that a patient

cannot be forced to buy medicines from the hospital pharmacy. In all these cases, the hospital should keep a record for future reference so they are not held responsible for some mishap due to wrong/spurious/improper medications. He also pointed out that the patients were unhappy with surgeons going on leave immediately after surgery which is reflected in many cases. While signing off, he pointed out that there are rising allegations of delayed/improper diagnosis, which have doubled against the previous year. Ravindra Mangal, Associate Director - Strategic Initiatives, Institute of Medicine & Law delivered the vote of thanks.

MARKET

Global Coalition Against TB organises MP roundtable meet Political leaders pledge to work at national, state and district level strategies to ensure that the country achieves the Sustainable Development Goals to End TB FORMER AND current Members of Parliament from across party lines have signed a pledge to proactively fight tuberculosis (TB) in the country, as part of a Members of Parliament roundtable organised by the Global Coalition Against TB (GCAT). Reportedly, the political leaders present committed to work at the national, state and district level and strategies to ensure that the country achieves the targets of the Sustainable Development Goals (SDG) to End TB. The Jagat Prakash Nadda, Union Minister for Health and Family Welfare; Dalbir Singh, President, GCAT; and leading Members of Parliament including Kalikesh Singh Deo and Jitin Prasada were present at the roundtable meet. “Providing affordable health care to the population is a priority for the government and we are committed to achieving zero TB deaths in as short a time frame as possible. Our Government is working towards ensuring that the Revised National TB Control Programme is adequately funded in a timely manner and we utilise innovative health mechanisms to increase engagement with the private sector to provide quality TB care to all TB patients. TB Harega, Desh Jeetega,” said Nadda. The Roundtable meeting served as a platform for political leaders to deliberate and discuss crucial interventions required to improve TB control in the country. Ensuring access to quality TB care, the lack of awareness, an under-prioritisation of TB and a low budget towards the Revised National Tuberculosis Control Programme (RNTCP) has impeded TB control efforts. “In 2014, it is estimated that more than two lakh Indians perished due to TB. It is heartening to see political leaders from across party lines expressing concern and pledging their support towards the cause that affects millions of lives. This is a landmark moment in TB control efforts for India and we hope to see positive policy changes in the

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April 2016

near future,” said Singh. “It is an unfortunate reality that India has the highest burden of a disease which is pre-

ventable and curable. While the efforts of successive governments have led to a substantial reduction of TB cases in the

country, the magnitude of the problem demands an increased prioritisation of the disease. My fellow parliamentarians and I

completely support the cause and we are committed to ensuring a TB-free India in the near future,” said Singh Deo.

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EVENT BRIEF MAY - JULY 2016 06

XVIII NATIONAL SEMINAR IN HOSPITAL & HEALTHCARE MANAGEMENT, MEDICO LEGAL SYSTEMS & CLINICAL RESEARCH

XVIII NATIONAL SEMINAR IN HOSPITAL & HEALTHCARE MANAGEMENT, MEDICO LEGAL SYSTEMS & CLINICAL RESEARCH Date: May 6-7, 2016 Venue: Symbiosis International University Lavale, Pune Organiser: Symbiosis Institute of Health Sciences

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(SIHS) Summary: This highlights of this year's seminar will be CONNEXIONS â&#x20AC;&#x201C; a workshop and placement drive, Master Classes, Star Alumnus Awards and Healer of Mankind Award. It would cover pertinent topics such as Role of Six Sigma in Healthcare, Game Changers: Telemedicine in Healthcare, Sustainable Healthcare Models, Changing paradigm

in HR, Enterprise Performance Management Special laws related to healthcare etc. Contact Dr Rajiv Yeravdekar Dean, Faculty of Health & Biomedical Sciences, SIU Phone: 91-020-25655023, 20255051, 08888892258, 09552588162/92 Email: info@schcpune.org, dep@schcpune.org Website: www.schcpune.org

MEDICALL 2016

MEDICALL 2016 Date: July 22-24, 2016 Venue: Chennai Trade Center, Chennai Organiser: Medexpert Business Consultants Summary: Medicall is a leading hospitals needs and equipment exposition in India. It brings the latest, appropriate and affordable

technologies, for the benefit of all hospitals including smaller hospitals, clinics, nursing homes and physicians setting up group practice. Contact Medexpert Business Consultants 7th Floor, 199, Luz Chruch Road, Mylapore, Chennai - 600 004, Tamilnadu, Email: info@medicall.in Website: www.medicall.in

HEALTHCARE SABHA 2016

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PAVING WAY FOR A PUBLIC HEALTH REVOLUTION IN INDIA An Indian Express Group and Express Healthcare initiative

Over 100 policy makers and stakeholders of public health came together at the first edition of Healthcare Sabha – The National Thought Leadership Forum on Public Healthcare. The two-day conference saw an interdisciplinary group of professionals working in public healthcare deliberate, discuss and debate on cohesive, unified and innovative ways to achieve the National Health Mission of providing ‘Universal Access to Equitable, Affordable and Quality Healthcare Services.’ Public health champions in India were also honoured at the Express Public Health Awards held concurrently Glimpses of the event ...

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HEALTHCARE HEALTHCARE SABHA SABHA 2016 2016

DAY 1 MARCH 4, 2016

HEALTHCARE SABHA 2016

INAUGURALCEREMONY

(L-R) Viveka Roychowdhury, Dr Srinath Reddy, Dr Henk Bekedam, Dr Kenneth Thorpe and Navin Mittal

◗ Inaugural ceremony ◗ Address by the Chief Guest ◗ Keynote address: Investing in health is investing in India's growth ◗ Models of financing public healthcare to aid the masses ◗ Genomics in precision medicine ◗ Emerging threat of lifestyle diseases and their risk factors - Where are we today and the way forward to deal with NCDs as a public health priority ◗ Importance of evidence backed public health strategies ◗ Panel discussion: Implementation of Universal Health Coverage/Assurance: 4-point road map ◗ Improvising healthcare by implementation of Health Informatics Solutions ◗ Medicine procurement: Assumption versus assurance of quality ◗ Panel discussion: Best practices in Quality Procurement Management in the public health system

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he 1st edition of Healthcare Sabha commenced on an auspicious note with the ceremonial lamp lighting ceremony by the Chief Guest, Navin Mittal, Secretary Finance & Commissioner & Ex-Officio Secretary, Information & Public Relations Department, Government of Telangana, and the Guests of Honour, Dr Henk Bekedam, WHO Representative to India, Dr Srinath Reddy, President, Public Health Foundation of India, Dr Kenneth

Thorpe, Chairman, Partnership to Fight Chronic Diseases. Viveka Roychowdhury, Editor, Express Healthcare also joined them on the dais. Supported by the National Health Mission (NHM) and the Government of Telangana, the two-day event was filled with interesting presentations and discussions to enhance the public health sector in India. It was attended by policy makers and stakeholders of public health from across the country.

Address byChief Guest

n his inaugural address, the Chief Guest, Navin Mittal, Secretary Finance & Commissioner and Ex-Officio Secretary, Information & Public Relations Department, Government of Telangana, welcomed the delegates to the city of Hyderabad and said that it is the ideal location to hold a healthcare conference as Telangana’s pharma and healthcare sectors are flourishing with leading players setting up base in the state. He also informed that Telangana was working towards augmenting its infrastructure, bettering its health indicators and imple-

menting initiatives which would help in providing quality healthcare to everyone in the state. He said that the two-day conference would be a great opportunity for the health

experts who had gathered at the event to find workable and scalable solutions which would help mitigate the challenges in the healthcare sector and create a roadmap for the future.

The two-day conference would be a great opportunity for the best brains in the country and abroad to deliberate and find solutions to a lot of issues that the healthcare sector faces and create a roadmap for the future

Navin Mittal | Secretary Finance & Commissioner & Ex-Officio Secretary, Information & Public Relations Department, Government of Telangana

KEYNOTE ADDRESS

Investing in health is investing in India’s growth Dr Henk Bekedam | (WHO) India representative

n his address, Dr Henk Bekedam, World Health Organisation’s (WHO) India representative called for more investments in healthcare and highlighted how essential it was to sustain India's economic progress. He pointed out that huge inequities exist in Indian healthcare. While a section of the population has access to top-quality healthcare facilities, a sizeable number of its citizens do not have access to even basic health amenities. He also lamented the fact that India, a rapidly growing country, still has a life expectancy rate of only 66 years and fares badly in comparison with its neighbours. In Bangladesh it is 71 years, while China had a life expectancy rate of 68 years back in the 1970s. He drew attention to the fact that India’s investment is just over one per cent of its GDP while drawing parallels with the investments made in its neighbouring nations. In China, it has

One additional year of life expecta ncy contributes to a rise in GDP per capita by four per cent risen to 3.5 per cent while Brazil, a BRICS country, invests five per cent of its GDP in health. Dr Bekedam cautioned that if India's doesn't invest in health, there will be serious adverse consequences. People dying prematurely is not only a big loss to the family but also to the society. He also opined that India should have more emergency preparedness to deal with sudden health challenges. He revealed statistics from a study which proves that one additional year of life expectancy contributes to a rise in the GDP

by four per cent. Analysing India's Union Budget for 2016-17, he said that the increased investment in health was an encouraging sign. He also lauded the move to launch around 3000 generic medicine stores in the country (Jan Aushadhi stores) as well as the support extended to improve dialysis care in the country. He also appreciated the move to provide Rs one lakh coverage per family and additional coverage of Rs 30,000 for its senior citizens. However, he also pointed out that there has been no increase in the budget for NHM and no significant measures to deal with diseases like kala azar, malaria, TB etc. He also advised improving public health and social health insurance to prevent people from slipping into poverty due to out-of-pocket expenses. He concluded by saying investing in human capital is very important to continue India's growth story.

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DAY 1

Models of financing public healthcare to aid the masses Chhitiz Kumar | CEO, Philips Capital & Headâ&#x20AC;&#x201C;Govt Affairs, PPP, Philips India

n this session, Chhitiz Kumar, CEO, Philips Capital & Headâ&#x20AC;&#x201C;Govt Affairs, PPP, Philips India spoke on the financing models that can be adopted to improve public healthcare in India. He also spoke on the quantum of investment that might happen in the coming times and highlighted three broad areas which needs significant financial investments in the next 10 years. The first area for investment is healthcare infrastructure since India requires more number of hospitals and more beds. It also needs to refurbish the existing healthcare set-ups. He said that this would require at least 10 per cent of funding from the government with the rest coming from the private sector. The second area for investment is insurance. As per Kumar, many state governments

The private sector should be encouraged to invest in public health in India are introducing health insurance programmes to the poor, but India has to achieve Universal Health Coverage (UHC). He informed that though the government has begun efforts to achieve the same, this area require a huge amount of investment. Kumar says that the third area is the primary care system in India. He feels that the basis of any healthcare system is its primary care and huge investments are needed to

strengthen this system. Kumar opined that we require good models of financing to ensure the inflow of such investments. He said that the government should increase spending on healthcare but also suggested that CSR is a good model to fund healthcare. He revealed that currently CSR contributes to around Rs 20,000 crores in India of which around 26 per cent of this amount is spent on healthcare. Thirdly, he said that the private sector should be encouraged to invest in public health. He then pointed out the significance of public private partnerships (PPP) in healthcare. Pointing out that PPP-led healthcare delivery is currently only 10 per cent in India, he advised that all stakeholders in healthcare should work towards increasing this share to improve healthcare access.

Genomics in precision medicine Girish Mehta | CEO, MedGenome India

irish Mehta, CEO, MedGenome India spoke on the developments in the field of genomics and went on to say that most of the risk factors for non-communicable diseases are in the human genes. He also explained the correlation between genomics and precision medicine. He further spoke about how genomics can bring down the cost of next generation sequencing. He also elaborated on the trends in healthcare, and opined that personalised precision medicine has the capability to change the face of healthcare. He laid special focus on how genomics is driving drug discoveries across the globe.

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There is an emerging ecosystem of innovative companies tackling specific problems related to human diseases using genomics-based approach He also emphasised that precision medicine backed by genomics will be the way forward. He provided insights on how genomics can be utilised in sectors like clinical research, pharmacogenomics, patient stratifaction, therapeutic monitoring, family screenings, prenatal and neonatal screenings, as well as other areas of diagnosis as well as prognosis. He said,

there is an emerging ecosystem of innovative companies tackling specific problems related to human diseases using genomics-based approach. Mehta also spoke on the genomic-led drug discovery market that is rapidly growing. Lastly, he stated that this market is estimated to be a $15 billion market in the next five years.

Emerging threat of lifestyle diseases and riskfactors - The way forward to deal with NCDs as a public health priority

5.2 million lives are lost in a year due to NCDs in India amounting to roughly 60 per cent of all deaths in the country sumption and physical inactivity, air pollution, stress etc. He accentuated that the huge NCD burden faced by India is not only a serious health concern but also an issue which has adverse implications on India’s economic growth. He also called for concerted efforts and strategic measures such as targeted awareness programmes about the need for a healthy lifestyle, early detection through screening programmes, infrastructure

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n his session, Dr Damodar Bachani, Deputy Commissioner (NCD), Ministry of Health & Family Welfare, Government of India called attention to the growing threat of NCDs, India’s preparedness to deal with it and the immediate measures to tackle this challenge effectively which otherwise would have serious adverse effects. He spoke on the rise of premature deaths. i.e. before the age of 70 years due to increasing incidence of NCDs such as cancer, diabetes, heart diseases and strokes and attributed it to causes such as tobacco use, unhealthy diets, alcohol con-

HEALTHCARE SABHA 2016

DAY 1 Dr Damodar Bachani | Deputy Commissioner (NCD), Ministry of Health & Family Welfare, Government of India

development and capacity building in terms of human resources, better emergency medical services, more effective health legislations and evidence-based as well as population-based interventions, as well as encouraging

research etc. for better NCD management in the country. He also gave an overview about the various programmes and initiatives undertaken by the Government of India to deal with NCDs. He concluded with the advice that the allocation for NCDs need to be increased and hoped that the National Health Mission and the 13 th five year plan would see improved allocation for NCDs as it would be crucial to win the war against this health menace.

Importance of evidence backed public health strategies Dr Soumya Swaminathan | Director General, Indian Council of Medical Research, Government of India

ICMR is working with various experts to derive at the disease burden estimates within the states to help decision makers take informed and responsible healthcare decisions for their people based on proper facts and evidences

r Soumya Swaminathan, Director General, Indian Council of Medical Research, Government of India started off her session by highlighting the importance of making healthcare decisions

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based on facts and evidences. She emphasised on the need to have a sound recording system to determine the cause of death as it would help in better decision making and help track disease trends. She pointed out that earlier deaths

caused by communicable and infectious diseases such as diarrhoea, malaria, pneumonia, AIDS and tuberculosis constituted to 60 per cent. But today, there has been a shift and the leading cause of deaths in India are non-communicable diseases (NCDs) that constitute to 60 per cent. Currently. she said that the three important diseases currently causing deaths in India are cardiovascular diseases, lower respiratory diseases and tuberculosis. She also pointed out that we

have missed our millennium development goals (MDGs) for maternal and child deaths by a considerable margin. Nevertheless she said that the government is hoping to achieve the sustainable development goals (SDG) through its various efforts. Moreover, she reminded that India does not have a good system to record the real causes of death of a person. The data that the government receives from hospitals and corporations on the birth and

death registered is not properly documented. She then referred to the 'million death study' and said that India needs to undertake a verbal autopsy method to arrive at the proper cause of death of a person. Later she informed about ICMRâ&#x20AC;&#x2122;s measures to put a system in place with the help of information technology. ICMR intends to train doctors from atleast 50-100 medical colleges from across the country to properly and systematically record the real causes of death within the country. She also informed that ICMR is working with various experts to derive at the disease burden estimates within the states to help decision makers take informed and responsible healthcare decisions for their people based on proper facts and evidences. Finally, she laid emphasis on the value of Big Data and its application in healthcare decision making. She summed up her session by talking about an endeavour that the ICMR has embarked on to develop a repository to store different data sets from across the country to help facilitate better healthcare decisions in India.

PANEL DISCUSSION

Implementation of Universal Health Coverage: 4-point road map

he first panel discussion at Healthcare Sabha 2016, focussed on the various ways and means to ensure Universal Health Coverage (UHC) for the citizens of India. The moderator of the session, Dr Srinath Reddy raised pertinent points such as the need to make UHC a pivotal part of the policymakers' agenda, raising public health financing in India, implementing effective PPPs in healthcare, improving primary care in the country, mobilising communities to become significant stakeholders in their own health etc. The panelists too drew inferences from their experiences of working in the public health sector and recommended measures that can be implemented to achieve the goals of UHC. Dr Henk Bekedam, WHO representative to India shared insights from his extensive experience in the public health sectors of different countries and spoke on the steps introduced by various countries. He also highlighted the unfortunate fact that in a fast growing economy like India, 60 million people are living in poverty as they have to foot their own healthcare bills. He also reflected that the case was similar in countries like China and Cambodia as well. Stressing on the importance of health and education for a country's progress, he emphasised that improving public health in a country is essential for achieving UHC. Dr PV Ramesh, Principal Secretary (R&E) Finance, Government of Andhra Pradesh highlighted the need to step up expenditure on public health and informed that it is happening at the state levels gradually. He also opined that health does not feature at the top of the policymakers' list because we still do not have a magic bullet for the sector. In healthcare, return on investments take a

Perhaps we need to define PPPs as partnership for public purpose than public private partnership Dr Srinath Reddy President, Public Health Foundation of India long time. However, he agreed that healthcare needs renewed focus and stated that at the state level they are experimenting with different ways and means to improve the care delivery system. At the same time, he said that India needs to tackle several healthcare concerns such as the growing double burden of communicable and non-communicable diseases. He urged the stakeholders to come together to arrive at a consensus on the solutions to tackle the challenges in India's public health sector and drive public health investments. Dr Gullapalli Rao, Chairman, L V Prasad Eye Institute, explained how the private and public sectors in health can collaborate for the greater good of the people. Stressing on the importance of innovation, he said that while innovation in any sector usually originates in the private sector or the social sector, it is upto to the government to scale it up. He also opined that public private partnerships (PPPs) need to be understood, planned and implemented in the true spirit. He went on to say that PPPs are

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HEALTHCARE SABHA 2016

(L-R) Dr Gullapalli N Rao, Chairman, LV Prasad Eye Institute; Mirai Chatterjee, Director, Social Security at Self-employed Women's Association (SEWA); Dr Srinath Reddy, President, Public Health Foundation of India (PHFI); Dr Henk Bekedam, WHO Representative to India; and Dr PV Ramesh, Principal Secretary (R&E) Finance, Government of Andhra Pradesh

failing because there is no clarity about what's expected from each partner at the outset of the project. He also explained LVPEI's model and how it helps offer equitable and comprehensive care to the populace while highlighting that it can be replicated across projects and different specialities of medicine. He recommended engaging the community in improving the efficacy of health initiatives. He also advised that there is a need to be constantly innovative, look at the real problems and tailor-make solutions which can then be tested and replicated to improve the healthcare scenario in the country. Mirai Chatterjee, Director, Social Security at Self-employed Women's Association (SEWA) spoke on the importance of mobilising communities to be active participants and take charge of their own health than being just passive recipients. She said that there is a need for a major mind set change to ensure that UHC is achieved. She also informed that in her experience of working with people at grassroot levels, especially the vulnerable population like the adivasis,

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In India, where economic growth is very important, 60 million people are in poverty because they have to pay their healthcare bills Dr Henk Bekedam WHO Representative to India dalits and women are very ready to be active participants. She pointed out that NHM has structures like the Mahila Arogya Samiti, village sanitisation and nutrition samitis etc where people can be mobilised. Thus, she recommended that we need to add one more 'P' to PPPs, to signify 'people'. She also said that multiple fora and platforms can be built and reenergised to engage people in the care-giving process and highlighted that many states

Communities need to be actively engaged to achieve our dream of UHC. There has to be major shift in mind set to change people from passive recipients to active participants who take charge of their own health Mirai Chatterjee Director, SEWA

are already mobilising their populace to improve health determinants. The panelists also deliberated on the measures to strengthen the primary care mechanisms in the country, utilising the available resources to do so. They also drew parallels between the

We still don't have a magic bullet. In healthcare, it takes a long time to recover the investments. However, there is a need for increased investment in the public health sector Dr PV Ramesh Principal Secretary (R&E) Finance, Govt of Andhra Pradesh

initiatives implemented by various countries to improve access to medicines, wherein Dr Bekedam recommended subsidisation and crosssubsidisation measures to improve healthcare access. The importance of capacity building and creating effective partnerships was also

There is a need to be constantly innovative, look at real problems and tailor-make solutions which can then be tested and replicated to improve the healthcare scenario in the country Dr Gullapalli N Rao Chairman, LV Prasad Eye Institute

emphasised. Thus, several crucial points were highlighted and discussed at the panel discussion. Dr Reddy concluded the discussion by saying that all said and done, these measures can be implemented in reality only if we build PWC i.e. political will and commitment.

Improving healthcare with Health Informatics Solutions DR BK Murthy | Executive Director, CDAC

n this session, Dr BK Murthy, Executive Director, CDAC, highlighted the various administrative and operational challenges in healthcare facilities and elaborated on the role of ICT in simplifying the processes while amplifying the benefits. He said that India is a leader in providing ICT solutions in the world and gave an overview on his organisation's offerings for the healthcare sector. He also informed that various public health stakeholders like state governments of Rajasthan, Maharashtra, Telangana, etc use CDAC's products. He also emphasised that healthcare delivery systems can be

Technology is a tool,it depends on the user to put it to the right use.Especially, in e-governance applications,unless the implementers take ownership,their effect will not be seen made more efficient and effective through implementation of health informatics solutions like HMIS, EMRs/EHRs, blood bank management systems, supply chain management systems etc. He detailed the different benefits offered by each of

these systems to the healthcare providers and the patients in the long run. He also advised that people/companies/governments opting for these solutions should take ownership for them and upgrade the systems to keep them working efficiently.

Medicine procurement: Assumption versus assurance of quality Dr Suresh Saravdekar | Ex Assistant Director & Consultant - Procurement, Ministry of Medical Education and Health, Maharashtra

r Suresh Saravdekar, Ex Assistant Director & Consultant - Procurement, Ministry of Medical Education and Health, Maharashtra addressed the need to ensure equity in the quality of medicines, in his presentation. He pointed out that despite being a crucial factor, it is often not achieved in the current scenario. Terming them as ‘therapeutic tragedies’, he drew attention to the fact that there have been several instances across the world where people have lost their lives due to poor quality of drugs or medicines. He reminded the audience that quality is not a static but a dynamic concept and emphasised how essential it is to constantly upgrade quality

Quality,safety and specificity are the three aspects that need to be considered in the procurement of medicines standards formedicines. He also outlined the various measures recommended by WHO to upgrade the quality of drugs. Quality, safety and specificity are the prerequisites that need to be considered in the procurement of medicines, according to Dr Saravdekar. He also urged India to actively pursue

cGMP as it is done in the developed countries. The session also comprised a comparison of quality standards and drug regulations followed in different countries and the best practices that India can inculcate to improve its own drug quality standards. He pointed out that we don’t have a one-for-all standard to accredit the quality of medicines. Medicines that are exported are of superior quality to those provided in the domestic markets. He also enlarged on the various other aspects which prevent quality standards from being met. Thus, he spoke on the need to change our mindsets from quality assumed to quality assured, when it comes to medicine procurement.

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HEALTHCARE SABHA 2016

PANEL DISCUSSION

Best Practices in QualityProcurement Management in the Public Health System

his session centred on ensuring equity in medicines and took its cue from Dr Suresh Saravdekarâ&#x20AC;&#x2122;s presentation. It went on to discuss the best practices to be adopted to create an effective procurement management system in the public health sector. Several significant aspects were highlighted by Dr Saravdekar, the moderator for this panel discussion and the panelists, Prof AK Gupta, Medical Superintendent, PGIMER, Chandigarh and Dr Avinash Supe, Director, Medical Education & Dean, KEM Hospital. They discussed and debated on the ways to ensure quality and equity of medicines, efficacy of generic drugs, measures implemented at KEM and PGIMER to meet quality requirement when it came to medicines etc. Dr Supe informed that the health sector in India is seeing the emergence of newer and more efficacious drugs on one hand, while huge disparities or inequities in drug quality continue to exist. Hence, public health professionals have the challenge of striking a balance wherein they have to ensure that patients receive the best care at the most reasonable prices possible. So, as an administrator, he tries to ensure that both, cost and quality are given their due importance at his hospital. Dr Supe also elaborated on the different aspects to be considered while checking the quality of medicines, especially while opting for generics. Dr Gupta also outlined the measures undertaken at PGIMER to ensure quality while procuring medicines. As PGIMER buys medicines

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Prof AK Gupta, Medical Superintendent, PGIMER, Chandigarh; Dr Suresh Saravdekar, Ex Assistant Director & Consultant - Procurement, Ministry of Medical Education and Health and Dr Avinash Supe, Director, Medical Education & Dean, KEM Hospital

Quality, not price, is the most important factor while it comes to procurement of medicines Dr Suresh Saravdekar Ex Assistant Director and Consultant Procurement, Ministry of Medical Education and Health

If you focus on specifications of medicines, then you can ensure both, quality and compliance with general financial rules while you are working with the government Prof AK Gupta Medical Superintendent, PGIMER, Chandigarh

Most of the time, we concentrate on chemo-quivalence, we should pay more attention to therapeutic equivalence as well when it comes to efficacy of generic drugs Dr Avinash Supe Director, Medical Education & Dean, KEM Hospital

worth Rs 25 crores each year, the hospital follows a rigorous process wherein drug manufacturers and suppliers have to register themselves with the hospital. Then the applicants have to meet certain criteria such as they should be actually manufacturing the medicines, have their own R&D unit and an audited turnover of Rs 100 crores. Dr Gupta claimed that these measures have helped to ensure quality to certain extent. The panel also discussed various challenges faced by medical practitioners and hospitals in verifying and guaranteeing the quality of drugs, over prescription of antibiotics and methods to prevent it, role of e-commerce platforms, dangers of self-medication, and the need to strengthen regulations and laws to safeguard quality.

HEALTHCARE SABHA 2016

DAY 2 MARCH 5, 2016

POWER DISCUSSIONS

Dignitaries discuss on drug procurement process at Healthcare Sabha HEALTHCARE SABHA 2016 ◗ Power discussions on drug procurement process ◗ Keynote Address: SANKALP - DISHA SWASTHA BHARAT KI: Implementing a national blueprint on NCDs ◗ Mobile and Cloud Solution for comprehensive Primary Health Management ◗ Power of Open Source Software within the public health space ◗ Digitisation of public healthcare institutions: Challenges and successes ◗ Hospital administration: Challenges and innovations ◗ Digital medical imaging in public healthcare – Way forward ◗ PANEL DISCUSSION: Models of financing public healthcare ◗ Need for frugal innovation in medical technology ◗ Skill enhancement programmes to bridge the workforce deficit ◗ Models of financing oncology medicines ◗ PANEL DISCUSSION: PPPs in public healthcare: Expanding role of NGOs, Foundations and Corporate Hospital Outreach Programmes in TB control ◗ PANEL DISCUSSION: The role of frugal innovations in medical technology

EXPRESS PUBLIC HEALTH AWARDS ◗ Welcome Address ◗ Chief Guest Address ◗ The future of public health in India: Suggestions for moving from MDGs to SDGs ◗ Felicitation Ceremony

ealthcare Sabha 2016 also saw two power discussions, presented by Glenmark Pharmaceuticals. The discussions offered several insights and food for thought. The first one kicked off with AG Prasad, Vice President – Sales and Marketing, Glenmark Pharmaceuticals welcoming the 15 dignitaries from Mumbai. The topic before the house was ‘Partnering in Quality Procurement.’ The discussion began with Dr Suresh Saravdekar, Ex-Assistant Director and Consultant (hospital supplies procurement), Ministry of Medical Education & Health, State of Maharashtra pointing out the need for quality medicine procurement processes within public hospitals. He went on to say, “Equity in quality of medicine is of utmost importance. We, as key stakeholders working in the public health domain, need to come up with solutions that can harmonise the standards for medical procurement. Today, we have gathered here to come up with those solutions that can make a difference.” This comment got the ball rolling for the rest of the interaction. Tarun Goel, Assistant Manager, KPMG, and Advisor to Maharashtra government said, “To ensure quality drug procurement, it is necessary to revisit the tenders that come in. Apart from this, quality checks is a must without which medicine procurement process

POWER BREAKFAST

15 dignitaries from Mumbai participated in the power breakfast organised at Healthcare Sabha

The topic before the house was ‘Partnering in Quality Procurement

is incomplete.” Dr KBK Dora, Additional Chief Medical Director, Central Railways immediately responded to these suggestions and said, “We need to have a filtration process in place for (purchases of) all kinds of medicine and surgical equipment. This will ensure quality procurement.” Agreeing with this view, Dr Nirmala Barse, Deputy Dean, LTMG Sion, said, “This needs a change in mindset.”

Dr Prateek Rathi, Special Executive Officer and Surgeon, Employees State Insurance Scheme, Public Health Department, Government of Maharashtra then emphasised that the medical procurement process must be kept transparent. “Transparency can be maintained by bringing in a third party to check for quality and then uploading the results on the Internet for everyone to see.” Sanjay Deshmukh, Additional Municipal Commissioner W S, Mumbai Munic-

ipal Corporation agreed with Rathi. He also endorsed the idea of using ecommerce to maintain transparency. Ram Bhau Dhas, Dy Municipal Commissioner (Z-III), Mumbai Municipal Corporation, replied saying, “We have to find all the loopholes in the current procurement mechanism and fix them so that we can improve the quality of drugs and equipment supplied to public healthcare institutes.” Further, Dr Avinash Supe, Dean, KEM Hospital,

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HEALTHCARE SABHA 2016

Mumbai recommended that a random inspection system be introduced by the government to ensure quality procurement processes. He also suggested that the price control mechanism should be reviewed once again. This suggestion by Dr Supe was lauded by all. Dr Alaka Deshpande, Former HOD – Dept of Medicine & Director, Center of Excellence, HIV/AIDS Management, JJ Hospital, said, “Quality is maintained within public hospitals as qualified doctors and healthcare staff conduct the procurement of medicines and surgical equipment.” Nevertheless, she pointed out that there is an urgent need to have a cap mechanism to ensure highest standards. Dr Yogesh Patil, CoFounder & Director, Biosense Technologies, also criticised the raised turnover criteria in the medicine procurement process. He was of the opinion that there is a need to find a new mechanism (other than turnover) to identify innovation-based companies to provide high quality products at affordable rates. To add more insight to the discussion and inform the dignitaries about the developments at the state government level, Dr Pravin Shingare, Directorate of Medical Education & Research, Government of Maharashtra, said, “Decentralisation of medical procurement should be stopped. There should be one agency who will look after the standardisation of the procurement process. Also, post procurement scrutiny is also required to ensure quality maintenance. Currently there is no control on the ageing of drugs.” He also pointed out that pharmacovigilance is crucial to provide good quality drugs to the people. Goel chipped in, “Maharashtra will soon come up with its HMIS model to maintain transparency. The government is also adopting 5S and Kaizen for process improvement.”

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POWER DISCUSSION

Government officials from various states were part of the second power discussion at Healthcare Sabha

The discussion revolved around the drug procurement process in different states of India

This news was appreciated by all at the discussion. The next suggestion came from Ganesh Kanate, General Manager- Corporate Affairs, Glenmark. He urged the need for a dedicated PRO for each public health facility/hospital as negative news about public hospitals is highlighted often, while positive news seldom get covered in the media. He therefore felt that if an agency is hired or a committee is formed, this could help disseminate the right information on the state of affairs within the public healthcare sector. Prasad concluded the discussion by thanking all the dignitaries for sharing their views on this extremely sensitive subject and coming up with ideas that can give rise to apt solutions. The success of the first power discussion set the tone for the second one which attracted state government officials from various states.

The conversation was once again led by Dr Saravdekar, who asked the other dignitaries to talk about the drug procurement process in their own states. Dr Manjunath B, Medical Superintendent, KC General Hospital, Malleshwaram, Bengaluru under the Government of Karnataka, spoke about the drugs procurement mechanism maintained within his state. He also highlighted the problems which his organisation is faced with currently and requested for a solution to overcome it. “Money is allocated for increasing access to medicine; however, we are not able to utilise it properly,” he added. Prasad agreed that underutilisation of funds by state health departments is a real concern. He then touched upon the budget allocation for the healthcare industry in the Union Budget 2016-17 and made a point that in India we

whine about the scarcity of funds but it is equally important to know whether these funds are efficiently utilised. “Most of the funds allotted to state and national programmes do not even get utilised. So to avoid such situations, both government as well as the private players should identify how to utilise it,” he stated. Moving on, Dr Pradeep Naik, Dean, Goa Medical College explained the procurement mechanism followed by his hospital. He informed that in 2014, the Goa government formed a common drug purchase committee to ensure quality drug procurement process and maintain high standards. “The core responsibility of the committee was to follow the National List of Essential Medicines (NLEM) list and procure medicines. However, the committee has also prepared non-NLEM drugs list and shared this with

all public hospitals located in Maharashtra”. Adding his views, Dr Shankar L Vig, Deputy Medical Commissioner, ESIC, briefed about the criteria adopted and followed by the ESIC for ‘Not of Standard Quality’ drugs and non supply of drugs. “We have a centralised committee that looks after this process. We follow a two-step standardisation process for quality checks,” he informed. During the discussion panelists also discussed how pharma manufacturers are not willing to manufacture certain drugs under price control which leads to scarcity of medicines in the market. For instance, Dr Atul Kharate, State TB Officer & Joint Director Health Services, Government of Madhya Pradesh raised concerns on the drug procurement process for TB treatment. He revealed that some TB drugs are not available in Madhya Pradesh and hence even the Revised National Tuberculosis Control Program (RNTCP) is facing many problems when arranging for certain drugs to treat TB. Dr PK Devadass, Dean and Director, Bangalore Medical College and Research Institute echoed Kharate’s point that he and his institution find it difficult to procure drugs. At the end of discussion, the participants were unanimous in their conclusion that functional integration is key to quality drug procurement in India. Dr Prathajyoti Gogoi, Director, Regional Drug Testing Laboratory, CDSCO, DGHS, Ministry of Health & Family Welfare, Government of India, summed up the discussion saying, “Healthcare Sabha has highlighted several problems being faced by stakeholders working in the public health domain. I assure you that I will discuss these issues at the ministerial level and present some solutions that have surfaced during our discussion.”

HEALTHCARE SABHA 2016

DAY 2 KEYNOTE ADDRESS

Sankalp – Disha Swasth Bharat Ki: Implementing a national blueprint on NCDs Dr Kenneth Thorpe | Chairman, Partnership to Fight Chronic Disease (PFCD)

he second day of Healthcare Sabha began with a key note address by Dr Kenneth Thorpe, Chairman, Partnership to Fight Chronic Disease (PFCD). He spoke on the rising incidence of NCDs in the world and highlighted India's burden of NCDs. He also pointed out that unless NCDs are brought under control, they will be a serious dampener to India's growth story. He also highlighted that the country is set to lose $4.58 trillion between 2012-30 due to the growing burden of NCDs. Dr Thorpe also gave an overview of PFCD's initiatives to curb the advance of NCDs in India. At the same time, he also imparted the good news that NCDs are preventable and can

We really need to develop a partnership between individuals, public sector and the private sector to define more efficient roles that everybody can play to resolve the problem of NCDs be brought under control with clearly outlined strategies. He also drew attention to the unholy nexus between poverty and NCDs. Moving on to the measures required to tackle the danger of NCDs from the country's horizon, he spoke on the need for effective partnerships between key stakeholders of healthcare in India. Dr Thorpe also urged cross-functioning of the

ministries for effective interventions such as reducing tobacco consumption, spreading awareness on the dangers of sedentary lifestyles, integrated chronic disease networks, stronger public healthcare systems etc. He ended his presentation with recommendations that would help create a blueprint to successfully tackle NCDs and better India's health indicators.

Mobile and Cloud solutions for primarycare management Sunita Nadhamuni | Head – Healthcare Solutions, EMC Software and Services India

n this session, Sunita Nadhamuni, Head – Healthcare Solutions, EMC Software and Services India, gave an overview on the potential of mobile and cloud based solutions to make primary care, the first frontier of a healthcare system, more efficient as well as effective. She also spoke on the various offerings by EMC in this arena. Pointing out the benefits of an efficacious primary healthcare system, she said that a stronger primary healthcare will take the pressure away

Stronger primary healthcare will take the pressure away from secondary and tertiary healthcare from the secondary and tertiary healthcare systems. She also mentioned the differ-

ent care areas that can be improved with the implementation of mobile and cloud solutions such as improved disease surveillance, management of communicable and non-communicable diseases, enhancing reproductive, maternal, newborn, child, and adolescent health services etc. Nadhamuni also spoke on the various initiatives they have embarked on with state governments such as Karnataka and Andhra Pradesh to create better primary healthcare systems.

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HEALTHCARE SABHA 2016

DAY 2

The power of open source software in the public health space Vivek Singh | Technical Architect, ThoughtWorks

ivek Singh, Technical Architect, ThoughtWorks began with defining open source software and its significant benefits. He went on to say that knowledge should not be kept within closed doors, it should be accessible to all. Singh also explained the difference between open source software and free software. He said that open source software makes the source code available to all. The users can utilise it and even change it to suit their requirements. Whereas, a free software is developed and provided for free but for any changes need to be made to

Knowledge should not be kept within closed doors,it should be accessible to all the software, one has to go back to the developer. Secondly, Singh spoke about the economics of utilising open source within the public health domain. He explained the myriad advantages

offered by the open source platform if it was efficiently adopted and managed. He also spoke on how open source can be utilised in the digital health space by comparing three well-known softwares used for maintaining electronic health records, healthcare management and health information exchange. Singh also presented a case study from Bangladesh that highlighted how open source software enhanced a healthcare information platform. He summed up saying that India certainly needs to go the open source software route to provide better healthcare delivery to its people.

Digitisation of public healthcare institutions Dr Deepak Agrawal | Head IT, AIIMS

r Deepak Agrawal, Head IT, AIIMS shared his experiences in implementing ICT in a hospital. He began by referring to an article from a leading newspaper which mentioned that the government's healthcare system was on life-support. He said that the reasons for this situation was that though ICT is being deployed in a lot of government service areas, it has not been able to permeate the healthcare sector. Dr Agrawal said that ensuring transparency and accountability were the key problems in hospitals. Hence, the focus while digitising the operations at AIIMS were on these two areas. The team also developed a model that can be replicated across the country. The other focus of this team was to im-

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Though ICTis being deployed in a lot of government service areas,it has not been able to permeate the healthcare sector prove patient satisfaction, an area which is often neglected in the public health domain. He also spoke on the various challenges faced by him and his team during the project. Dr Agrawal also enumerated on a few strategies that he and his team implemented at the hospital. One among these, was

starting a call centre at the hospital to improve patient satisfaction. The other strategy was to have an audit in place to improve efficiency of the doctors and support staff. The hospital also developed a system that was tamper-proof to handle medico-legal cases, medical records of patients. He claimed that this strategy was appreciated by many state governments in India and the model will soon be replicated at many government hospitals across the country. He spoke on the patient display system they installed in the emergency ward and AIIMSâ&#x20AC;&#x2122; patient appointment system which have helped improve their operations and care delivery. He summed up by saying that these strategies have helped the hospital to benchmark its services.

Hospital administration: Challenges and innovations Prof AK Gupta | Medical Superintendent, PGIMER Chandigarh

n his session, Prof AK Gupta, Medical Superintendent, PGIMER Chandigarh, emphasised that innovation is way to go to tackle challenges in hospital administration. He urged hospital administrators to come up with creative solutions to improve the administration process in a hospital. He then provided a case study from PGIMER Chandigarh hospital wherein it faced certain challenges connected to a court summons from the High Court of Punjab and Haryana and shared how solutions such as tele-evidence (video-conferenceing network) helped to resolve the issue effectively. He also spoke about how the hospital leveraged information technology to enhance

Smart innovations have a positive impact on a hospitalâ&#x20AC;&#x2122;s functioning tele-conferencing and build medical evidences. Prof Gupta further informed that PGIMER Chandigarh had requested the High Court of Punjab and Haryana to grant the hospital permission to produce medical evidences in the court of law to support their cases. This move helped to strenghten their case further. Moreover, Prof Gupta also provided data on the number of tele-evidences sched-

uled and conducted within the hospital between 2014-2016 and explained how this move helped them save money. He also presented the measures which have helped the hospital to bring down its carbon footprint. Prof Gupta presented another case study which helped them reduce the average length of stay within the hospital and explained how a decision support system (DSS) helped the hospital to optimally utilise their resources and thereby reduce the patients' hospital stay while offering them better care. He concluded by recommending the adoption of smart innovations as they positively impact the hospital's functioning.

Digital medical imaging in public healthcare - The wayforward Sabu Jose | General Manager, Government Accounts, Carestream Health India

abu Jose, General Manager, Government Accounts, Carestream Health India, started off by talking about the acute shortage of resources in the healthcare sector. He pointed out that only 30 per cent of India's population has access to healthcare with 1:1833 bed ratio in the public sector and 1:100000 ratio when it came to radiologists in the country. Jose also highlighted the challenges in increasing access within the public health domain. Providing solutions to these challenges, he elaborated on how India can make the best use of the available resources by making them more productive and recommended doing it with

Digitalistion is a building block for healthcare delivery in India the help of digitalisation. He cited an example of how a radiology department can be efficiently run with less number of technicians through digitalisation. He said that it would also help in getting optimal results and diagnose more number of patients. Jose also opined that digitalistion is a building block for creating an effective healthcare

delivery system in India. Further, he presented a video that explains how a digital radiology system works. He also elaborated on how it enhances the productivity of a radiology department and how the digitalised data from the three to four hospitals' radiology departments can be integrated using a cloud platform. Moreover, Jose spoke about effective digitalisation of a PACS unit to increase efficiency within the hospital and how PACS can be integrated with cardiology, endoscopy, dental and many other vital departments within a hospital. He summed up the session by explaining Carestream Health's offerings in the public health space.

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HEALTHCARE SABHA 2016

DAY 2 PANEL DISCUSSION

Models for financing public healthcare

his panel discussion revolved around solutions to finance public health in India. Dr Prateek Rathi, Special Executive Officer, ESI Scheme, Department of Public Health, Maharashtra was the moderator for this session. He touched on pivotal issues in financing public healthcare and examined the efficiency and effectiveness of the current models of financing healthcare in the country. The panelists also highlighted several strategies to finance public health in India, challenges faced during implementing these strategies and the way forward. They also shared their recommendation to improve financing in public health. Dr Rathi commenced the discussion by asking Kavita Singh, Director, NHM (Finance), MoH&FW, Government of India about current strategies adopted by the government to finance public health. Singh explained how the budget allocations are made by the government and revealed that getting more money for health is always a challenge. She said that the total spending on health by both government and private sector amounts to four per cent of our GDP out of which government spending stands at one per cent. She also said that if the government spending in public health increases by 2.5 per cent, India could have better health indicators. She also informed that our current budget allocation is 33 per cent of the entire Union Budget for 2016-17 which is a good move as healthcare allocations earlier have been restricted to 20 per cent of the overall allocation. With this, she pointed out that healthcare is slowly getting its

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(L-R) K Srivatsava, VP Marketing and Sales, NATCO Pharma; Dr Anant Phadke, Senior Advisor, SATHI-CEHAT; Dr Prateek Rathi, Special Executive Officer, ESI Scheme, Department of Public Health, Maharashtra; Kavita Singh, Director NHM (Finance), MoH&FW, GOI; Chhitiz Kumar, CEO Philips Capital& Head-Government Affairs, PPP Philips India;

due and that it is no more just a state subject. Singh indicated that the increased allocation of funds can be effectively utilised to bring down MMR and IMR rates in India. Analysing the current budget allocations she said that the most impressive part of the government announcements for this year was the devolution of taxes. Although this move has not yet taken off, its mandate will help the state governments to provide more allocations of in their budgets toward health. Apart from this, Singh also drew attention towards the growing incidence of communicable diseases (TB) and non-communicable diseases (diabetes, CVDs and cancers) which has led to increased out-of-pocket spending on healthcare. She then recommended that India needs a basket of models that includes different ways of financing public health. Dr Rathi also pointed out that drug costs are also increasing out-of-pocket expenditure for patients. K Srivatsava, VP Marketing and Sales,

India needs a basket of models that includes different ways of financing public health Kavita Singh Director NHM (Finance), MoH&FW, Government of India NATCO Pharma took up the conversation and said that itâ&#x20AC;&#x2122;s important for Indian companies to challenge patents as these patented drugs become unaffordable to the common man in India and sometimes even to the rich. Nevertheless, he said that government's compulsory licensing policy has made it mandatory for pharma companies to provide 600 medicines for free to cancer pa-

There is a need for better understanding of health economics amongst the Indian government Chhitiz Kumar CEO, Philips Capital & Head-Government Affairs, PPP Philips India tients. Additionally, there are a lot of schemes that are floated by the state governments that provide free medicines to poor patients but the only problem in oncology is that there is a limit beyond which the firms cannot provide free drugs as patients require targetted therapy. Srivatsava also spoke about the role of philanthropic institutes and their contributions in this regard. However,

Universal Health Coverage is impossible to achieve without predominant government funding in health Dr Anant Phadke Senior Advisor, SATHICEHAT he felt that the government's effort in providing overall cancer treatment to patients are significantly less. He laid emphasis on the rising service taxes for various commodities and said that these accumulated taxes can be utilised in providing healthcare to the poor patients. Moving further, Dr Rathi said that the government is falling short of resources and

there is an urgent need to augment these resources. He asked Chhitiz Kumar, CEO Philips Capital& Head-Government Affairs, PPP Philips India to share his thoughts on the same. Kumar pointed out that there is need for better understanding of health economics in our country. Referring to a Lancet report he informed that if we invest 1x amount of money on health, the returns on investment over a period of time and across countries would be around 10-12x. This fundamental is still not understood by the government. He went on to say that the government needs to understand that any investment in healthcare will not yield returns in 5-10 years and might take decades to do so. Kumar reiterated Singh's recommendation of have multi-financing options for healthcare.

Taking the discussion forward, Dr Rathi mentioned that investing money alone will not suffice, we need to develop systems and capacities. He stated that we need to have an equitable, accessible and affordable healthcare system for India. He then urged Dr Anant Phadke, Senior Advisor, SATHI-CEHAT to take the discussion further and share his views on this subject. Dr Phadke asserted that Universal Health Coverage is impossible to achieve without predominant government funding in health. Increasing private sector financing will not help according to Dr Phadke as this will only lead to added out-ofpocket expenditure. He said that we can use some insurance areas funded by the private sector but a major source of funding in health has to

come from the government. Moreover, he emphasised on the importance of public procurement of drugs and devices to bring down the costs. In this way we can use our capabilities efficiently to tackle the problem of financing in healthcare. He also accentuated on the need for transparency within the public healthcare system. The panelists also discussed on the inefficiencies within the system and finally came to a conclusion that a multi-financing model will be beneficial to build a strong healthcare system in India. Dr Rathi summed up the discussion by saying that the government has to increase its spending, decrease inefficiencies within the system, maintain transparency and create synergies.

There is a need to challenge patents as these patented drugs become unaffordable to the common man in India and sometimes even to the rich

Investing money alone will not suffice, we need to developed systems and capacities. We need to have a equitable, accessible and affordable healthcare system India

K Srivatsava

Dr Prateek Rathi

Vice President Marketing and Sales, NATCO Pharma

Special Executive Officer, ESI Scheme, Department of Public Health, Maharashtra

Frugal innovations in healthcare Gyanesh Pandey | Chairman and Managing Director, HSCC

yanesh Pandey, CMD, HSCC began his session by elaborating on HSCCs contributions in the public health sector in India. He spoke about HSccâ&#x20AC;&#x2122;s role in increasing healthcare access through its chain of hospitals and building healthcare infrastructure at a lower cost. He also threw light on how HSCC has been using frugal innovations to expand healthcare access in ophthalmology through its low cost medical devices such as intraocular lens which is often used in cataract surgeries. Pandey stressed that there is a dire need for frugal innovation in healthcare as they not only help the poor patients to get access to healthcare at a cheaper cost but also fosters a healthy ecosystem for start ups in India. Further on, he

Start ups in healthcare are working hard to come up with innovative devices which would bring down costs yet improve health access

mentioned that Indiaâ&#x20AC;&#x2122;s start up culture is growing, especially in the healthcare sector with several good example sof frugal innovations coming up in this space. Start ups in the healthcare space are continu-

ously working hard to come up with innovative devices which would bring down costs yet improve health access. He opined that most of these innovations are coming up in the fields of ophthalmology, cardiology, diabetes and infectious diseases. Pandey also pointed out to the measures by the Chinese government to start ups and other medical devices companies to come up with medical innovations. Lauding the efforts, he said that today, China has a thriving medical innovation culture. He concluded his session with a call to all stakeholders to come together and encourage frugal innovations in healthcare. He said that this will also boost medical tourism is India, solve many healthcare challenges and improve the quality of life of the people in India.

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HEALTHCARE SABHA 2016

DAY 2

Skill enhancement programmes to bridge workforce deficit Prof PR Sodani | Dean (Training), IIHMR University

rof P R Sodani, Dean (Training), IIHMR University spoke on how India can enhance its existing workforce in healthcare to bridge the current deficit of skilled manpower. He touched upon significant subjects such as importance of skilled workforce in healthcare, nature of the healthcare workforce crisis, causes for the scarcity, measures to overcome this challenge, and the way forward. Prof Sodani began with informing that the WHO has recommended six essential building blocks for strengthening the healthcare system of countries across the globe. Governance, health information, financing, human resources, medical technologies and medicines are the six building blocks

India needs to increase the number of skill development centres within the healthcare space that can strengthen any healthcare system, he informed. According to Prof Sodani, an effective workforce is that which is available when needed, competent enough to perform their duties, responsive enough to the task given to them and be productive. Human resource occupies around 47 per cent of the health budgets globally. Therefore, managing the health

workforce in country is very important. He referred to a study and said that less motivated workforce delivers poor quality of healthcare service. Prof Sodani also spoke about the need to create a good density of workforce and said that when a country has a high density of workforce, the nation has a strong healthcare system. Further, he pointed out that India needs to increase its workforce within the National Health Mission and focus on getting the right mix of people to work in this area. He also advised that India needs to increase the number of skill development centres within the healthcare space and changing the training content of skill development programmes to improve their efficacy.

Models of financing oncologymedicines K Srivatsava | Vice President - Marketing & Sales, NATCO Pharma

Srivatsava, VP-Marketing & Sales, NATCO Pharma raised concerns on the rising burden of cancer and the rising cost of treatment. He underlined that though there are several government health schemes, not many provide full coverage to cancer treatment in our country. He mentioned that the contribution of philanthropic organisations is also not enough to deal with the huge burden posed by cancer and a lot more has to be done for the treatment of oncology patients. Srivatsava further urged the audience to focus their efforts on building a strong healthcare system for cancer

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EMI scheme will provide better adherence to cancer care in India and ensure completion of the therapy

care in the government sector. He then suggested the introduction of equated monthly installment (EMI) schemes for cancer care. He said that currently 25-30 per cent of

patients get cancer treatment, but with the introduction of EMI schemes, more percentage of cancer patients will be in a position to avail treatment. This will also provide better adherence to cancer care in India and ensure completion of the therapy, he stated. Additionally, he explained how the EMI scheme works within the healthcare sector. Srivatsava also informed that so far the EMI scheme is working well in cardiac care, early 550 loans have been availed in India for cardiac care. If this scheme is implemented effectively in oncology care, it can certainly make a huge positive impact and more patients can be cured of cancer in India.

PANEL DISCUSSION

Expanding role of NGOs,Foundations & Corporate Hospitals’outreach programmes in TB control

his panel discussion focussed on the enormity of TB as a public health concern and the role that prolific partnerships between private and public stakeholders of health can play in tackling this threat effectively. This session’s moderator, Dr Atul Kharate, State TB officer/Joint Director Health Services, Government of Madhya Pradesh commenced the discussion by highlighting that in India, there is hardly anyone who can say with certainty that no member in his/her entire family suffers from TB. Yet, despite its growing incidence, TB often does not receive the attention that it deserves as a public health priority. He called it a ‘stigmatised disease’, but also admitted that with effective health campaigns, the awareness about the disease is rising and TB is losing its stigma. However, he emphasised that there is a long way to go before we vanquish the disease and stated that effective public private partnerships (PPPs) can be of immense help in this endeavour. He also discussed on the various ways that private and public sectors can combine their resources and expertise to eliminate the scourge of TB with his panelists. Dr Sreenivas A Nair, National Professional OfficerTuberculosis, WHO, Country Office for India spoke on the role of the private players in TB management. He said that efforts to control TB would not have the requisite effect unless the private sector is

successfully engaged in the public health programmes. He said that the government should become an efficient facilitator of good TB treatment and not just the provider. For each TB patient handled in the public sector, two patients are handled by the private sector. He also elaborated on the various models being used to expand access to TB care and improve its efficacy, including the use of ICT to improve treatment of TB. The other panelist, Dr Aravind Swaminathan, Paediatrician, MSF who has worked in a drug-resistant TB programme in Tajikistan, shared learnings from his experiences in handling paediatric TB and pointed out the measures that could be replicated in India as well. He also spoke on the challenges in diagnosing TB in children and lobbied for better diagnostic procedures and effective screening programmes to handle the disease better. He also urged the government to increase budget allocation for TB management and also elucidated on the ways the private sector could be involved in enhancing TB care in the country. He also rooted for developing innovative and yet affordable models of care with workable and scalable PPPs to treat TB. The panel also discussed the challenges in TB care and the way forward for managing the disease in the best possible manner. The moderator concluded the session with an appeal to the media to be more sensitive and responsible when it came to TB reporting.

(L-R) Dr Sreenivas A Nair, National Professional Officer-Tuberculosis, WHO, Country Office for India; Dr Atul Kharate, State TB Officer/Joint Director Health services, Government of Madhya Pradesh; and Dr Aravind Swaminathan, Paediatrician, MSF

30 to 40 per cent of our population is infected with tubercle bacillus, so we are all sitting on a time bomb. There is a 10 per cent chance of getting TB in everybody’s lifetime Dr Atul Kharate State TB Officer/Joint Director Health Services, Govt of MP

The government should become an efficient facilitator of good TB treatment and not just the provider Dr Sreenivas A Nair National Professional OfficerTuberculosis, WHO, Country office for India

Though India spends a sizeable amount on TB care, a lot more is needed. This is where the public and private sectors can collaborate Dr Aravind Swaminathan Paediatrician, MSF

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HEALTHCARE SABHA 2016

DAY 2 PANEL DISCUSSION

Role of frugal innovations in medical technology

he last panel discussion of Healthcare Sabha 2016 focussed on increasing healthcare accesibility and affordability with the help of frugal innovation. The moderator of the session Dr Jitendra Kumar Sharma, Director, WHO collaboration Centre for Priority Medical Devices & Head, Division of Healthcare Technology, National Health Systems Resource Center (NHSRC), MoH&FW highlighted how frugal innovations can mitigate the challenges that hinder us from achieving Universal Health Coverage. He touched upon subjects related to effective implementation of health diagnotics programmes, use of teleradiology in increasing access to public health, importance of public private partnerships (PPP) in healthcare and what role frugal innovations play in optimising public healthcare delivery. The panelists shared their insights on the kind of innovations available for enhancing public health delivery and also provided some examples of public healthcare programmes that have been efficiently implemented using frugal innovations. Dr Sharma began the discussion by speaking about Universal Health Coverage and how providing diagnostic care should be the primary focus. He said that Universal Health Coverage in the true sense should cover every vertical of diagnostics. He shared some inferences from his experience of working with some renowned public health programmes where they have used frugal innovations to provide effective care to a large volume of patients. He also raised questions about the procurement process for innovations in the government sector. He said that innovations have to be unique and

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(L-R): Dr Yogesh Patil, COO, Biosense; Mihir Shah, Founder and CEO, UE LifeSciences; Dr Jitendra Kumar Sharma, Director, WHO collaboration Centre for Priority Medical Devices & Head, Division of Healthcare Technology, National Health Systems Resource Center, MoH&FW; and Dr Pankaj Parashar, Director & General Manager. MP Public Health Services Corporations

We wish to partner with the government in its endeavour to provide dialysis care Dr Pankaj Parashar Director & General manager. MP Public Health Services Corporations

Our innovation is well accepted by the people using it; however the challenge is to scale it up Dr Yogesh Patil COO, Biosense

India is slowly building a start up ecosystem which is receiving a lot of encouragement from all stakeholders of healthcare Mihir Shah Founder and CEO, UE LifeSciences should be easy to adopt or implement. He further suggested that the government should have a single trade contract for any innovation to be procured and funded by the National Health Mission. He questioned to the other panelists on how their innovations have been suc-

cessfully uitlised in the public health domain. Dr Yogesh Patil, COO, Biosense spoke about his innovation and provided information on the national health programme in Andhra Pradesh wherein his innovation has been used to provide healthcare serv-

Innovations have to be unique and should have the potential to be practically utilised Dr Jitendra Kumar Sharma, Director WHO collaboration Centre for Priority Medical Devices & Head, Division of Healthcare Technology, NHSRC, MoH&FW ices to the rural poor. He also mentioned that apart from the public sector, his innovation has been used in the private sector, especially within the pharma industry. Further, he spoke about the challenges he is currently faced with. The biggest challenge is to increase the scale

of the product. Mihir Shah, Founder and CEO, UE LifeSciences pointed out that India is slowly building a start up ecosystem which is receiving a lot of encouragement from all stakeholders of healthcare. He said that in the past few years many avenues have opened for start ups in the healthcare space. NHSRC, NGOs such as Wish Foundation and Path, partners such as Tata Trust and state governments such as Rajasthan have encouraged the utilisation of innovations in the public health domain and create the impact that they wished for. He then talked about his innovation which is a point-of-care device for breast cancer screening. He said that this device can be used by a primary healthcare worker easily and efficiently. He also mentioned that this device has been made available to nearly 10,000 healthcare workers in rural India through various philanthropic organisations. Dr Pankaj Parashar, Director & General Manager. MP Public Health Services Corporations spoke about his innovation on detecting proteins in the urine which would be useful to detect, hypertension and preeclampsia in pregnant women. He said that his innovation is in the protype phase and will soon begin its clinical trials. Also, this device can be utilised for detecting kidney disorders. Further, he disclosed that he wishes to collaborate with the government to work on its dialysis programmes. Finally, the panel came to the conclusion that Indian innovators, along with other stakeholders of health, will have to work together to mitigate the challenges in scaling up innovations and increasing their reach to the masses.

AWARDS

PUBLIC HEALTH CHAMPIONS

HONOURED AT EXPRESS PUBLIC HEALTH AWARDS Public Health Foundation of India and Glenmark join The Indian Express Group and Express Healthcare in this endeavour

he first edition of Express Public Health awards was held at Mariott, Hyderabad on March 5, 2016. It was a part of Healthcare Sabha, a two-day conference which was attended by policymakers and stakeholders of public health to deliberate on cohesive, unified and innovative ways to achieve the vision of the National Health Mission. The Express Public Health Awards sought to honour the visionaries, innovators, and game changers in India's public healthcare. It began with a welcome address by Viveka Roychowdhury, Editor, Express Healthcare. She spoke on the vision behind the awards and expressed her thanks to Public Health Foundation of India, the Knowledge Partner and Glenmark, the Presenting Partner. Dr Srinath Reddy, the Chairperson of the jury for Express Public Health Awards took the stage to explain the concept and the need to encourage initiatives that help improve public health in India. Dr Akun Sabharwal, Director, Drug Control Administration, Telangana was the Chief Guest at Express Public Health Awards. He spoke on the initiatives to improve healthcare in his state and emphasised on the need to improve access to medicines in the country. This was followed by the felicitation ceremony. The winners were as follows: ✦ Express Public Health Award for Efficiently Run Public Health Programmes by a State: It went to the State Government of Chhattisgarh for innovative

initiatives in developing human resources for health aimed at improving outreach of services to difficult to reach populations, exemplified by the Mitanin programme, operationalisation of SNCUs and incentivising health personnel in extremism affected areas. ✦ Express Public Health Award for the Most Effective Public Private Partnership: It was given to HLL Lifecare, Tamil Nadu for their exemplary initiative in producing low cost sanitary napkins, for promoting affordable menstrual hygiene for adolescent girls and women. ✦ Express Public Health Award For The Most Effective Healthcare NGO: Nari O Shisu Kalyan Kendra, Howrah received this award for effective community action to overcome resistance to polio vaccination and routine immunisation, and increasing coverage rates through impactful behaviour change. ✦ Express Public Health Award for the Most Effective Health Technology System: All India Institute of Medical Sciences (AIIMS), Delhi won this award for operating an efficient online appointment system for OPD services, resulting in high levels of patient convenience and satisfaction Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh received it for developing innovative health information management software for optimising average length of stay for patients in hospital, thereby decreasing costs and increasing turnover. ✦ Express Public Health Award for Lifetime

Achievement Award for Contribution in Public Health: It went to SEARCH, Gadchiroli for path breaking contributions to community-based healthcare of children and women, with impactful research-led programmes of health service delivery in a developmentally backward region of rural Maharashtra. ✦ Jury Choice Award For Socially Responsive Healthcare Delivery by Private Institution: It was jointly awarded to Aravind Eye Care System, LV Prasad Eye Institute and Sankara Nethralaya for inspirational leadership in providing high-quality eye care to millions through pro-poor services extending from hospitals to communities. ✦ Jury Choice Award For Corporate Contributions To Public Health: GVK-EMRI was given this award for providing emergency health transport services across the country, through an innovative PPP model. Piramal Swasthya Management Institute also won in this category for providing health information helplines and mobile diagnostic services in several states, through PPP models. The evening came to a close with a Vote of Thanks to all the jurists, Dr Srinath Reddy, President, PHFI; Keshav Desi Raju, Former Secretary, in MoH&FW; Dr Jayaprakash Narayan, former Member of National Advisory Council (NAC), and Second Administrative Reforms Commission (ARC); Dr Leila Varkey, Senior Advisor-RMNCH, Centre for Catalysing Change as well as all the dignitaries who were part of the two-day summit.

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HEALTHCARE SABHA 2016

DAY 2 THE MOST EFFICIENTLY RUN PUBLIC HEALTH PROGRAMMES BY A STATE

THE MOST EFFECTIVE PUBLIC PRIVATE PARTNERSHIP

THE MOST EFFECTIVE HEALTHCARE NGO

STATE GOVERNMENT OF CHHATTISGARH

HLL LIFECARE, TAMIL NADU

NARI O SHISU KALYAN KENDRA, HOWRAH

THE MOST EFFECTIVE HEALTH TECHNOLOGY SYSTEM

LIFETIME ACHIEVEMENT AWARD FOR CONTRIBUTION IN PUBLIC HEALTH

AIIMS, DELHI

PGIMER, CHANDIGARH

SEARCH, GADCHIROLI

THE JURY CHOICE AWARD FOR SOCIALLY RESPONSIVE HEALTHCARE DELIVERY BY PRIVATE INSTITUTION

THE JURY CHOICE AWARD FOR CORPORATE CONTRIBUTIONS TO PUBLIC HEALTH

GLENMARK, THE PRESENTING PARTNER

LV PRASAD EYE INSTITUTE

PIRAMAL SWASTHYA MANAGEMENT INSTITUTE

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April 2016

EXPERT SPEAK OPINION

HEALTH IS TRULYWEALTH Elaborating on the theme of his key note address at Healthcare Sabha, 'Investing in health is investing in India’s growth', Dr Henk Bekedam, WHO Representative to India urges the country to step up investments in public healthcare as it would be pivotal to sustaining India’s economic growth

nvesting in health is investing in India’s growth story. It is not a cliché and there is a body of evidence that suggests that investment in health reaps dividends in growth and development.

India’s growing economy India’s GDP per capita has doubled between 2000 and 2014. India’s current economic growth, estimated at 7.6 per cent, places the country at a higher growth trajectory than any other large economy, including China, which grew 6.9 per cent in 2015. This trend in economic growth in India is expected to continue in the coming years. Economic growth has created an opportunity for the health sector in India. With an emerging upper middle class in India, new segments of the Indian population are demanding access to affordable and quality healthcare. Healthcare is one of the fastest growing sectors in India. The country is a leading destination for medical tourism for quality healthcare at a relatively low cost. India is also recognised as the pharmacy of the world, manufacturing and exporting low-cost quality drugs and vaccines.

Investing in health However, economic growth and centres of excellence do not automatically translate into good health for the entire

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population. The impressive economic growth has not been accompanied by commensurate progress in human development in India. Improvements in life expectancy and the health of the average Indian have lagged behind. India with a Life Expectancy (LE) of 66 years (2013) has a relatively low LE as compared to countries like China and Brazil that have a LE of 75. Even countries with slower economic growth have a higher life expectancy than India, such as Bangladesh with 71 and Nepal 69 (2013). Although there are multiple factors for relatively low life expectancy, one factor stands out for contributing to this and that is India’s persistent low level of investment in health. Among the BRICS countries, India has the lowest level of public health expenditure. Other BRICS countries spend at least 2.5 times more than India in GDP terms. While India’s public expenditure on health is around 1.2 per cent of GDP, Brazil’s spends 4.7 per cent of its GDP and China’s 3.1 per cent on health. Higher priority given to health has clear positive economic consequences. The reverse is equally true. While many in India have been lifted out of poverty due to economic growth and opportunities, around 60 million Indians are pushed into poverty due to high out-of-pocket

Higher priority given to health has clear positive economic consequences. The reverse is equally true. While many in India have been lifted out of poverty due to economic growth and opportunities, around 60 million Indians are pushed into poverty due to high out-of-pocket health expenditures

(OOP) health expenditures. This is around four to five per cent of Indian population and unfortunately has not declined over the past years. High OOP expenditure is linked to uncertainty of financial support or protection, which leads people to save money to ensure that their families will have access to health when needed. High savings rates reduce the ability to contribute to the economy. Consumer spending is an important factor to move to sustainable economic growth, an issue that emerging economies, like China, are still struggling with. India can take an early lesson from their experience. Not investing enough in health and not protecting the society sufficiently can have enormous economic consequences. SARS and Ebola outbreaks remind us of the need to invest in protecting society from the threat of diseases. The three West African countries affected by Ebola have lost 12 per cent of their combined GDP due to the epidemic. Much of this economic and human loss could have been averted with adequate investment in the health systems of these countries. Given this context, it is imperative that health expenditure is considered an investment that contributes to sustained economic growth. The recent Economic Survey 2015-2016 echoes this sentiment. It has emphasised that further investment in health is needed for India to achieve its long-term potential growth rate. Macroeconomic studies by Harvard University confirmed that one additional year of life expectancy contributes to an increase in GDP per capita of four per cent. The Draft National Health Policy 2015 by the Ministry of Health & Family Welfare argues for government expenditure on health to move toward 2.5 per cent of GDP by 2020. It is important that this policy pronouncement is translated into reality.

Economic growth poses health challenges too A growing economy, urbanisation and a burgeoning middle class are leading to an increase in sedentary lifestyles, changing diets and higher burden of NCDs. India has seen an explosion of NCD risk factors and diseases such as diabetes, hypertension, cardiovascular diseases and cancer. From a current estimate of 60 million diabetics, it is projected to at least double by 2030. GDP growth needs more energy. India relies heavily on coal for its energy. This has accelerated air pollution in India’s cities to one of the highest level in the world and is a major cause of cardiopulmonary, chronic obstructive pulmonary diseases and cancer.

India healthcare budget 2016-2017 Advocating for investing more in health is crucial, but which areas to invest in is an equally critical question. Three strategic directions are important for improving health of the entire population: ◗ Investing in public health – promotion, prevention, and protection; ◗ Improving services, especially in rural areas, and ◗ Setting up a system that people do not go into poverty when they fall ill. The 2016-17 health budget suggests positive developments with an overall increase by around 13 per cent in comparison to the previous one. The budget includes opening a further 3000 generic medicine stores across the country and building and improving centres for kidney dialysis. In addition, the proposed National Health Protection Scheme, which will provide coverage up to Rs 1 lakh per family and additional coverage of Rs 30,000 for senior citizens, is an excellent opportunity to move further in the direction of ensuring that every Indian citizen is covered through Social Health Insurance.

The 2016-17 health budget suggests positive developments with an overall increase by around 13 per cent in comparison to the previous one However, the not so good news in the budget is that there seems no clear indication of increasing investment in public health, which is much needed for elimination of diseases (kala-azar, lymphatic filariasis, malaria, leprosy), increasing immunisation coverage, tuberculosis and NCD challenges.

UHC and starting the journey Notwithstanding the encouraging steps in the budget, more needs to be done. It would entail accelerating progress towards Universal Health Coverage (UHC) in India. The current scheme, Rashtriya Swasthya Bima Yo-

jana (RSBY) is arguably not fully realising its potential as it is merely a safety net for the poor; and not covering other vulnerable groups or others. However, RSBY set up is nationwide and can be strengthened and a good basis for social health insurance in the states. The principle of universality is critical to achieve UHC. The proposed National Health Protection Scheme should not only be the insurance for the poor but for everyone, allowing pooling of funds and cross-subsidisation where the rich subsidise the poor, the young subsidise the old, and the healthy subsidise the sick. This is also an im-

portant step to make the scheme sustainable in the long run. The Social Health Insurance model also offers great opportunities through their purchasing function to get better value for money in general and connect with the private sector, which in the Indian context treats the majority of the patients. For progressing towards UHC, we know from experiences of other countries that you do not have to be rich to begin the journey. Extending health insurance coverage to the entire population will need to be a long-term goal, introduced step by step and relying on strategies that focus on the informal sector and the most vulnerable population groups. One practical example of such a step-by-step approach is to start with universal coverage for smaller packages, such as NCDs and maternal and child health, as a priority public health intervention. As India continues on its path of economic growth, the package can be expanded and financial protection increased so that all Indians have access to all the needed health services without suffering from financial hardship. This is clearly a journey for which more investment in both public health and social health insurance is needed. Therefore, it is important to define and agree on the vision and goals for 2030. This involves agreeing on a process for developing such a vision. This entails development of a national framework and roadmap that defines the roles of the Centre and the states, besides that of both public and private sectors. Investing in such a journey is investing in India’s human capital, which is critically needed for India to sustain its remarkable economic growth in the future. Economic growth has the attention of the policy makers in India and investment in health should get similar attention.

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April 2016

BUDGET SPECIAL OPINION

Innovative health financing options for India Bhavesh Jain, who leads International knowledge linkage programme at ACCESS Health International, and Nehal Jain, Regional Director, Foundation for Research in Health Systems analyse the allocation for health in the current budget and provide some alternatives to finance healthcare

DESPITE SLOWING global economy, Indian economy is growing at an accelerated rate of 7.6 per cent in 2015-16. The Finance Minister, Arun Jaitley in his budget speech, mentioned that healthcare is one of the nine pillars for the development of the country. The budget allocation of Rs 38,892 crores to the health sector for the year 2016-2017 is a welcome move for the country. There has been a 15 per cent increase as compared to last year’s allocation yet it is not enough. The Indian healthcare system is characterised by low public spending on health and high out-of-pocket payment by the people at the point of availing healthcare services. Individual households contribute about 70 per cent of the total healthcare costs through out-of-pocket payment at the time of illness. It creates financial barriers to access healthcare services and many of those who access services suffer financial catastrophe and impoverishment. On the other hand, the coverage of insurance is very low. The allocation of Rs 38,892 crores is estimated to be 1.3 per cent of GDP. This rate has been stagnant for the last few years. But, there are several important aspects in the current budget which will reduce out-of-pocket spending and improve protection by providing health insurance coverage. The budget should also be

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lauded for some of the indirect measures which will help improve health outcomes. The universal coverage of cooking gas in the country will not only empower women but also reduce the incidence of several illnesses related to cooking fuel. The allocation of Rs 9,000 crores for Swachch Bharat Abhiyan would help in prevention and control of diseases. Initiatives like the ‘Prime Minister Jan Aushadhi Yojana’

under which 3000 stores are planned to be opened for generic drugs will also help reduce out-of-pocket payment by people in case of illness. Other initiatives like the National Dialysis Service Program with funds through public private partnerships (PPP) will provide dialysis at all district hospitals. This will help an estimated 2.2 lakh renal patients added every year in India avail dialysis

services and reduce out-ofpocket expenses. The Government of India is also clearly taking leaps towards Universal Health Coverage by increasing the revised allocation on health insurance almost five-fold in the year 2016-17. The Rashtriya Swasthya Suraksha Yojana, a National Health Protection Scheme (NHPS), has been announced and plans to cover Rs one lakh per family with

BHAVESH JAIN ACCESS Health International

NEHAL JAIN Regional Director, Foundation for Research in Health Systems

a top-up of around Rs 30,000 for people above the age of 60 years. This is more than a three fold increase in coverage from Rs 30000 per family covered under the Rashtriya Swasthya Bima Yojana (RSBY). One of the aspects that has not been covered in the budget seems to be an investment in primary healthcare services. They are the foundation on which the health sector stands

upon. Investing in primary healthcare will improve the populationâ&#x20AC;&#x2122;s health as well as reduce a major share of the burden on the hospitals. It will also help in bringing down hospitalisation expenses. Hence, there is an urgent need to improve quality and access to primary care. A long-term vision to sustain the developmental agenda for healthcare will help India achieve better results. It can learn from the examples set by other countries. Thailand achieved universal health coverage through its three main insurance programmes including the Universal Coverage Scheme, the Social Security Scheme and the Civil Servant Medical Benefit Scheme. The Universal Coverage Scheme provides coverage for both primary and secondary care to the poor and the underserved. Thailand uses strategic methods for purchasing healthcare services from providers, where the costs of benefit packages are well defined. Also, there is a clear split between the purchaser and the provider of healthcare services. This kind of health insurance system can be beneficial for a country like India as well. If a resource-constrained country like Thailand can achieve Universal Health Coverage, India too has the potential to undertake a bold step. In India, the government plays the role of a purchaser as well as the provider of services. This dual structure increases inefficiencies and the cost of administration. Therefore, the government will need to have a clear vision when it comes to splitting its role as a provider and as a purchaser of services. In India, 70 per cent of healthcare services are provided by the private sector. So, there is a need for proactive efforts from the government to involve the private sector in its initiatives. GVK Emergency Management Research Institute is a good example of a successful public private partnership (PPP) where investments have been made by the private sector in the form of technology, leadership and systems develop-

In India, 70 per cent of healthcare services are provided by the private sector. So, there is a need for proactive efforts from the government to involve the private sector in its initiatives. However, PPPs should be adopted with caution and learnings from failed partnership models should be taken into account ment. However, PPPs should be adopted with caution and learnings from failed partnership models should be taken into account.

Raising revenue for the health sector Though there is a need for increasing direct government spending on healthcare, we also need to look at alternative financing mechanisms for health which the government can adopt to raise revenue. Some of the developing countries have adopted innovative methods for financing the social sector with considerable progress. Earmarking the taxes onproducts such as tobacco and liquor for healthcare helps in raising revenue for health promotion and services. Earmarked taxes are those whose revenue is designated to be spent on a particular programme or use. They are implemented in the form of sin taxes levied on products which are harmful for health. High-tax measures for tobacco not only raise revenue but are also effective in reducing its consumption in various segments of the population. Article 6 of the WHO Framework Convention on Tobacco Control recognised tax measures and also provides guidelines to implement these measures. The Australian state of Victoria implemented the world's first such sin tax that was earmarked for health in 1987. It came in the form of a tobacco control legislation that added a five per cent levy on tobacco products. This revenue was then used to fund a newly formed, independent

health promotion foundation called VicHealth. Apart from increasing cigarette prices, the legislation banned most tobacco advertising and formed the basis for later rules to create smoke-free workplaces and public venues. In Ghana, a 2.5 per cent health insurance levy is added to Value Added Tax (VAT) on goods and services. VAT on goods and services were one of the several sources of financing for the National Health Insurance Fund. 60 per cent of the funds for NHIF comes from VAT. The UK, recently in its budget, announced sugar tax on the soft drink industry. This has been hailed by celebrities and public health campaigners in the UK. Such taxes may not be enough to plug the resource gap, but will surely reduce the burden on the existing resources of the health system. The French Polynesia is another successful example of levying tax on the soft drink industry, both on production as well as import of soft drinks. Countries like Finland, the Republic of Korea, Portugal, Thailand, Belgium, Egypt, the UK as well as some of the US states of Alaska, Maryland, Massachusetts, Michigan, Oregon and Utah have instituted some marked a part of their tobacco taxes for healthcare. Egypt, for example, earmarks a part of the revenues from tobacco taxes for subsidising health insurance for students, covering preventive, curative and rehabilitative health services. The Government of India in its budget has increased tax on

cigarettes, the excise duty has been raised from 10-15 per cent on tobacco products other than beedis. Pollution cess of one per cent is levied on small petrol, liquefied petroleum gas (LPG) and compressed natural gas (CNG) cars, 2.5 per cent on cars of certain specifications; four per cent on higher-end models. These additional taxes are transferred to general pool and are not earmarked for specific use. These sin taxes should be earmarked separately for the purpose of achieving Universal Health Coverage and should not be transferred to the general pool. Philippines has earmarked excise duty on alcohol and tobacco to fund the reforms for Universal Health Coverage. Last year in May 2015, employee provident fund had Rs 27000 crores lying unclaimed. The full or partial amount can be invested to generate an interest. This interest amount can then be allocated to primary healthcare reforms. Leveraging these dormant funds can be useful to fund specific healthcare programmes of the government.

Efficient use of available resources Though it is important to increase public spending on health, it is equally important to utilise the available funds in the most efficient way. A research conducted by the Centre for Budget and Policy Studies in Karnataka suggests that the public health facilities are not always able to utilise the allocated funds to them and even if some of the health facilities spend the

funds, they are not efficently deployed. Evidence-based approach in healthcare policy making, especially in resource constrained settings, is to be encouraged. In times when healthcare budgets are limited and there is pressure to attain better health outcomes for the population, there is a need to bring in efficiency and important support tools for the decision makers at various levels. In the Indian health system, policy decisions are characterised by lack of evidence. Economic evaluation of healthcare programmes, technology, drugs and equipment would help in deciding cost-effective interventions to bring the overall healthcare costs down. Targeted and cost-effective interventions would help in providing the right mix of healthcare services at every level. Sharing knowledge across various countries is also one of the important ways in which a country can learn. Initiatives like the Joint Learning Network for Universal Health Coverage has been successful in developing practitioner-to-practitioner learning between countries striving to move towards Universal Health Coverage. A similar platform for knowledge sharing at the national level to develop linkages between the states could be very useful and effective in answering common challenges in health. Above all, political leadership is an important factor to bring about a major change in the health system. India can learn from the leadership of Prof Dr Recep Akdag, Former Health Minister, Turkey who has been the architect of the Health Transformation Program. His commitment and leadership transformed the health systems of Turkey in a span of just 10 years from 2002-2012, providing Universal Health Coverage at affordable cost. It is a great example that positive change can be brought about in the existing systems to provide high quality health services at lower costs. India can learn from such successful approaches to achieve Universal Health Coverage

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STRATEGY I N T E R V I E W

‘HSSC Karnataka proposes to set up a model chapter which will be replicated in other states’ Healthcare Sector Skill Council (HSSC) of India recently launched its Karnataka chapter. Dr Alexander Thomas, Chairman, HSSC, Karnataka State speaks to M Neelam Kachhap about the ecosystem for quality vocational education and skill development in the healthcare sector

What is the current state of skilled manpower in the Indian health sector? India is expected to be home to a skilled workforce of 500 million by 2022. About 12 million people are expected to join the workforce every year. There are over 11 lakh allied health professionals like nursing associates, sanitarians, medical assistants, medical equipment operators, optometrists, traditional and faith healers, physiotherapists, dieticians and dental assistants across the country. Yet, it is still short of the current demand. The National Skill Development Corporation (NSDC) has estimated that incremental human resource requirement in India's healthcare sector will double to 74 lakh by 2022. Besides, the size of the healthcare sector is expected to grow to Rs 9.64 lakh crores by 2017. Why has skill development in healthcare been neglected? In the past 65 years, we have spent most of our time talking about education. Lakhs and crores were spent in education and we thought imparting skill was part of education. But skill development did not happen

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and it remained neglected. Academics is different from skill development and we have to understand that. India has spent generously on education and kept neglecting skill development, which has today resulted in a huge shortage of skilled workforce needed by the industry. In India, even today we don’t have entry-level, skilled manpower which the industry demands highly. How is HSSC bridging this gap? HSSC identifies skill gaps in various allied healthcare job roles through market surveys, occupational mapping and functional analysis. It also frames National Occupational Standards (NOS) and develops high quality courses and training modules for job roles. These training modules are as per the competency framework developed by HSSC. Quality check as well as building accreditation and certification mechanisms for institutes and students are also part of HSSC’s roles. It is setting up an Academy of Excellence (AOE) for capacity building. It also intends to enable maximum employment of SSC-certified personnel within the healthcare sector.

The Karnataka Chapter of HSSC aims to ensure that the allied healthcare staff are also accredited and skilled after undergoing standardised training

Why did HSSC launch the Karnataka Chapter? What are its goals? In the Governing Council meeting it was found imperative to expand the regional presence of HSSC. Karnataka Chapter has been launched to help the allied health workers who play a major role in delivering quality health care service with direct impact on patient safety and comfort. The Karnataka Chapter aims to ensure that the allied healthcare staff are also accredited and skilled after undergoing standardised training, bringing in a higher degree of professionalism at all levels. Karnataka has taken the lead in major health initiatives. HSSC Karnataka proposes to set up a model chapter which will be replicated in other states. Goals of HSSC Karnataka Chapter ◗ Scaling up the skill development activities ◗ Creating awareness about Qualification Pack – National NOS), HSSC ◗ Development of National Occupational Standards ◗ Accreditation of training providers ◗ Conduct ‘train the trainer’ and ‘training the assessor’ programme

As the Chairman of HSSC Karnataka, what would be your immediate priority? My immediate priority would be to spread awareness about HSSC. The other priorities would be: ◗ To have nationally recognised accredited programmes running at various colleges ◗ To give the opportunity to those who want continue studies for professional courses with career progression. ◗ To provide manpower to expanding healthcare services. ◗ Affiliate new institutes and recommend new courses based on need. What are your plans for HSSC Karnataka? Among other things, what we really want to focus on in the near future is ‘Train the Trainer’ programmes as it helps to train the medical professionals for different job roles of allied health on the basis of National Occupational Standards set by HSSC. We would also want to enrol eligible students (by affordable institutions). In short, help in providing quality, affordable healthcare in our country. mneelam.kachhap@xpressindia.com

STRATEGY CASE STUDY

Can community owned mutual micro insurance provide healthcare for all?

KUMAR SHAILABH Executive Director, Uplift Mutuals

Kumar Shailabh, Executive Director, Uplift Mutuals shares an alternate healthcare financing model and outlines its benefits in a country like India where over 70 per cent of healthcare expenditure is done out-of-pocket IN THE summer of 2002, a self-help group of women in the slums of Pune were sitting in front of an insurance salesperson, who was explaining to them, a health insurance product. The group had recently lost a member to a bypass surgery done too late and the consequent financial indebtedness that the family of the deceased member was facing. On completing his presentation, the insurance professional asked the women if they had questions for him. One of the members who had been listening attentively asked him as to what will happen to their money when they are not sick. The insurance professional in his wisdom replied that they will benefit financially (exponentially in relation to the premiums paid) when they fall ill similarly when they don’t fall ill, he stands to benefit from the one time premiums they paid. Looking at other group members, the woman said “then there is no incentive to remain healthy because when we are healthy, you are the one making money!” This profound insight by the woman member stumped the organisation who was scouting for a relevant health insurance product to offset financial indebtedness that a poor household faces when a health shock occurs. They thought maybe a more relevant product needs to be found out and in order to do this they first needed to understand healthcare financing needs of poor households. Consequently, a survey of poor households was commissioned in the slums of Pune. What came out of the survey results

In a country where policy making is about large numbers, arguments of scale have been constantly used to compare such models against mainstream and state sponsored insurance models, however there has been very little interest in understanding such schemes or supporting them on a continuous basis or at a large scale was even more surprising-only a very small percentage of the studied population wanted health financing, majority of the poor households were ready to pay to know where they could get a good doctor, a good treatment at a good cost. There were multiple cases found where the households had spent astronomical amounts of money on seemingly low cost treatments. The organisation knew that health insurance products in the market did not answer most of the needs identified and something else would have to be designed to meet the needs of the poor households that including health financing should promote being healthy and provide access to quality health care that was also affordable. The organisers were worried about the design of the available insurance products not matching with what they had found from the field, the fine print of exclusions and the opaque claims process. They were also acutely aware of the fact that there would be no control on the year on year rise in premiums and as years pass the households may not be

able to afford the same. Thus was born the idea of creating a mutual model and it was named as Uplift Mutual. In a country where 70 per cent of the total health expenditure is made by households and 25 per cent is financed by governments at various levels1, out of pocket expenses, remain the dominant form of health care financing. Healthcare expense remains one of the major reasons why India’s poor remain in debt. While the past decade saw several public health financing schemes mop up impressive enrolments through the public private partnership model (where the risk is carried by commercial insurers and premiums subsidised by the government) access to and affordability of quality healthcare for all, especially the poor, remains a work in slow progress. Voluntary health insurance permeation in the country remains low and limited (to salaried class) as awareness about insurance and distribution and transaction costs of offering voluntary insurance especially to the poor continues to remain high. For poor households with a

daily income of $ 2-6 primarily employed in the informal sector with little or no access to social security schemes, health is not a prime concern till a destabilising event happens. Lack of correct information on care facilities and proper guidance on healthcare issues forces poor households to rely on unscrupulous medical care providers. This leads the family into further poverty as they either borrow money or mortgage/sell their assets to meet health expenses. The Mission statement of the National Rural Health Mission estimates that a single event of hospitalisation leads to over 25 per cent of families slipping below the poverty line in India. Amidst all this and the demand to universalise health care through public financing (which again is supply led), there are efforts on ground, where households-(demand led) poor households have organised themselves to setup and manage their own health financing needs through what is known as health mutuals. Uplift Mutuals is one such pioneer of this bottoms-up, grassroots, and demand

led approach in healthcare financing. Using an eco-system approach, Uplift Mutuals has learnt over the years, that in order to build sustainable, efficient and effective healthcare financing mechanism for the poor, it’s essential that poor households are both customers and managers of such a scheme. That such a scheme should facilitate access to quality care at affordable prices by design. That such schemes should focus not only on the curative aspects of care but build in preventive and promotive aspects of healthcare because there are limits to financing-especially by the poor. That such schemes should invest in building outpatient services as frontline service and gate keeping mechanism and seek complementarities with public healthcare. That such schemes should be well planned, developed and designed and be run professionally using data for making informed decisions. The mutual model of Uplift provides for a member designed and managed healthcare financing model where on becoming a member households not only share their health financing risks, participate in the governance of the scheme at different points, but also share prevention, guidance and a multi layered network of healthcare providers. Unlike most healthcare financing arrangements that have a top to down approach, in the mutual model the contribution to the scheme, which events will be financed and Continued on page 51

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STRATEGY INSIGHT

Taxing tobacco products India: A public health virtue

SARIT KUMAR ROUT Indian Institute of Public Health Bhubaneswar, PHFI

Sarit Kumar Rout, Indian Institute of Public Health Bhubaneswar, PHFI emphasises on the need for tougher tobacco regulations for the best interests of people's health and points out the loopholes in the current taxation measures

A POWERFUL mechanism by which the government can control tobacco consumption is raising prices of tobacco products through higher taxes. Evidence from around the world supports this view and therefore countries are initiating efforts to make tobacco products unaffordable through appropriate fiscal policies. Despite being the third largest producer and second largest consumer of tobacco in the world and losing one million people to the habit every year, India has not been able to use tobacco taxation policy to its advantage. For the financial year 2016-17, the central government has proposed to increase the union excise duty on all tobacco products by 10-15 per cent excluding beedi. The exclusion of beedi though is questionable from a public health perspective, and the overall moderate increase in excise duty defeats the purpose of tax reforms introduced in 2014-15 budget. During 2014-15, the then newly elected government introduced some wellintentioned reform measures in tobacco taxation, which were commendable. For the first time there was such a large increase in the tax rate on low priced, unfiltered cigarettes. The basic excise duty on the lowest tier unfiltered cigarettes (<65mm) increased to Rs 1280 per 1000 sticks from Rs 509 per 1000 sticks in 2013-14 and the tax rate on 65 to 70 mm length was fixed at Rs 2335, which

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was 34 per cent higher than the filtered cigarette of same length. During 2015-16, the government proposed to enhance the excise duty on cigarette not exceeding 65mm by 25 per cent and 15 per cent for cigarette of other lengths. The proposed hike of 10-15 per cent in 2016-17 is the lowest in last three years. The earlier initiatives could have been reinforced in the current budget to discourage consumption of low priced cigarettes by reducing the price differentials between various lengths of cigarettes. India still has a six tier product structure and a multi-tiered excise tax system for it provides leeway to producers to manipulate tax increments and enables product substitution for in wake of a price rise. A 2015 WHO report from last year observes that India is in the group of 37 countries that uses complex, tiered taxes leading to greater variability in tobacco product prices. A WHO report from 2015 has highlighted Indiaâ&#x20AC;&#x2122;s complex tax also and has found that cigarettes have become more affordable in India between 2008 to 2014 like in China, Indonesia and Vitenam whereas they have become unaffordable in neighbouring countries like Bangladesh, Pakistan, Thailand and Philippines. Similar findings were observed in a recent study Tobacco Taxes in India: An Empirical Analysis com-

missioned by Indiaâ&#x20AC;&#x2122;s Health Ministry and WHO India, which states all tobacco products have become affordable since real incomes have risen quicker than prices of tobacco products between 2006-2013. In fact, price indices of essential food products have risen in comparison to tobacco during the study period. Adding the most recent tax increase (2014-15), it is observed that though the relative price indices of cigarette have gone up more than food products, for beedi and chewing tobacco prices are still less than food products (see the figure). This study also reveals that Indiaâ&#x20AC;&#x2122;s total tobacco taxes make 58 per cent

of retail price in India, which falls well short of the WHO recommended 70 per cent of excise rate. Another major shortcoming of the current fiscal policy stance is that non-cigarette products, particularly beedi continues to be taxed at low rate. The current effective tax rate at 2.1 paise per stick for machine made beedis and 1.2 paise for manmade remained unchanged in the new budget proposal. Keeping beedi out of ambit of the excise tax hike for the last three years is uncalled for where more than nine per cent adult Indians smoke the product. Since beedi smoking is largely concentrated among the socio-economically disadvantaged groups, they are more likely to have health hazards due to multiple factors. With growing evidence showing poverty and low health status of beedi workers, the unfavourable tax treatment to beedi neither achieves the health nor the revenue objective. Beedis contributed only Rs 404 crore on average (0.12 per cent of gross tax revenue) to the exchequer in thelast 12 years. One recent study by PHFI shows that excise on beedi can be increased by 100 per cent of the current excise without any loss of revenue. This study suggests that the total revenue from beedi can be enhanced to Rs 430 crore leading to a decline in beedi consumption. The low tax rate has resulted in an ap-

pallingly low level of total tax burden at about 20 per cent of the retail price in 2012-13. Besides the low tax rate, the tax exemptions provided to beedi manufacturers producing less than two million beedi sticks per year incentivizes manufacturers to retain beedi production as a small scale industry. This only furthers the informal growth of the beedi industry, which accounts for more than 95 per cent of total beedi manufacturing. The tax incentive has led to exploitation of millions of beedi workers (3.5 million full time and 0.7 million part time) by the manufacturers who deprive them of their basic entitlements. Most of them are underprivileged either due to non-application of the Minimum Wage Act or partial application of social security provisions. In contrast, many believe that this sector provides large employment and is a potential source of revenue to the government. However, the health cost of Rs 1045 billion (2011) attributable to tobacco related diseases cannot be ignored. Besides smoking products, a substantial number, around 21 percent adults use smokeless products. The current budget proposed to increase the tax rate on chewing products from 70 per cent to 81 per cent in 2016-17. However, the compounded levy scheme applicable to paan masala, gutkha and chewing tobacco and the duty payable as per capacity of the machine, com-

STRATEGY plicates the governance and administration of tax. Further, the industry strategy to produce various brands with low unit prices has not become effective in reducing consumption in spite of a tax increase. This is further complicated either by a very low rate of tax or exemptions provided to the raw materials: betel leaves, betel nuts, and areca nut powder. Given the myriad varieties of tobacco use and the complex and inconsistent taxation system, Indian consumers have a wider choice of tobacco alternatives than in the South Asian Region. There are close substitutes available in the market encouraging product substitution in the event of a price rise. However, in order to check the growing menace of tobacco, which largely contributes to the increasing incidence of noncommunicable diseases, the government should stop differential tax treatment of tobacco products, which bene-

The multiplicity of the tax system by the union government, which not only makes the tax administration difficult but also provides scope for tax evasion, needs to be corrected. Similarly, it is imperative to introduce uniform tax rates across states to curb free movement of goods in order to achieve the principles of sound public finance fits the industry at the cost of nationâ&#x20AC;&#x2122;s health. In contrast to middle and high income countries, where tobacco is uniformly taxed, the governmentâ&#x20AC;&#x2122;s efforts to tax tobacco products differently in India and more specifically keeping beedi out of the tax net may usher short term political gains. But in the long run, the nation has to bear the huge cost for treatment and prevention of diseases attributable to tobacco use and house-

holds have to undergo unexpected misery due to loss of their family members in the productive age group. The effective increase in prices resulting from the current tax hike depends upon the VAT levied at the state level, which varies across for the smoked and smokeless products. States in India are given power to impose VAT on tobacco products and due to divergent tax rates, the tax system does not seem to be ef-

ficient as there is free flow of goods from low priced to high priced states. The multiplicity of the tax system by the union government, which not only makes the tax administration difficult but also provides scope for tax evasion needs to be corrected. Similarly, it is imperative to introduce uniform tax rates across states to curb free movement of goods in order to achieve the principles of sound public finance. The new budget

proposal has undermined reforms around tobacco taxes introduced in the past two years to make the tax rate competitive as per the international standards. The growing illegal cigarette market resulting from a cigarette tax increase as claimed by trade lobbyists (if true) should not be the sole criteria to forgo tax increase in India and make it comparable to international tobacco control norm. Strengthening tax administration, increasing enforcement and imposing severe penalty will help controlling the illegal trade as it is done in countries like Italy, Romania and Spain. Finally, reducing the tier based tax system and uniformly taxing all tobacco products could minimise the adverse health impact and at the same time maximise the revenue potential. (The author teaches health economics and financing and researches on healthcare financing and tobacco economics)

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Can communityowned ... what will not be is decided by members participating to it. So whether itâ&#x20AC;&#x2122;s charging the same contribution irrespective of age or covering events like caesarian is done by members. In a highly unregulated and opaque healthcare sector in terms of pricing and quality like ours, it makes sense to invest in removing asymmetries of information. Bearing in mind that poor households need access to quality healthcare at affordable prices along with health financing, the mutual model has invested in creating a multilayered access that includes local referral service, outpatient services, a 24X7 helpline, and a network of preferred providers. For the very first time these households get access to a range of health access services that help them to navigate the complex and often confusing healthcare sector in India. Member households

have saved lakhs of rupees by going to the most appropriate healthcare provider, thanks to these services. In the Mutual model emphasis on members understanding of the scheme and their participation in the governance of the same is crucial for its sustainability as they manage the scheme and take decisions. Uplift invests in training its members on managing the scheme at various levels and different points of the scheme. This helps them to understand the intricacies of how a health financing scheme works and makes them informed customers. A major critique of bottoms-up or demand led models of healthcare financing has been that they are informally managed and perhaps that has been the reason why very few have survived over a period of time or been able to replicate. At Uplift, data driven

decision making, design and delivery has been at the core of its operations. Uplift partnership with TEITO (an IT company) ensured that it entire operations are run systematically and hence an elaborate management information system(MIS) has been setup over the years that has allowed households to take technically sound decisions. This MIS in now converted into a cloud based system and has allowed Uplift to replicate its health mutual in even far-flung tribal populated areas like Dungarpur (Rajasthan). Women members play the risk sharing game as part of designing their health financing scheme, Dungarpur, Rajasthan. While there have been many bottoms up models of healthcare financing in the past (according to an ILO study in 2008 there were over 50 such schemes, The International Co-

operative and Mutual Insurance Federation (ICMIF) in association with the Insurance Institute of India will soon publish a landscape study including the current status of such schemes in India), very few have survived while others have chosen to co-opt with social security schemes. In a country where policy making is about large numbers, arguments of scale have been constantly used to compare such models against mainstream and state sponsored insurance models, however there has been very little interest in understanding such schemes or supporting them on a continuous basis or at a large scale. Such demand led models are nevertheless relevant in a country like ours as according to a recent ICMIF study there are over six lakh cooperatives and roughly 240 million households as cooperative mem-

bers. If a universal healthcare (and financing) programme has to be built in this country grassroots-people participating- models will need to be part of such design in order for them to be impactful and sustainable solution, which would otherwise be heavy for the state exchequer in the long run. A two level model, where low cost but high frequency health risks are managed by such community based health mutuals and high cost low frequency health risks are borne out of dedicated public funds seems to be both impactful and sustainable design. It is essential that the demand side of health care financing is organised in a manner that it provides access and affordability to all including poor households and for such a system to evolve in the country health mutuals can play a critical role.

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â&#x20AC;&#x2DC;We have succeeded in identifying and managing 2000+ high risk cases in five yearsâ&#x20AC;&#x2122; Express Public Health Awards 2016, held concurrently with Healthcare Sabha, recently honoured several public and private organisations for their excellent work to improve the public health sector in India. Piramal Swasthya Foundation won the Jury Choice Award for Corporate Contributions to Public Health at the event for their Asara Tribal Health Program. Col Kanwar Badam, VSM Head, Piramal Swasthya Foundation, divulges more details of the project, its impact, their other initiatives in the public health space and the way forward to revolutionise public health in India, in an interview with Lakshmipriya Nair

Congratulations on winning the Jury Choice Award for Corporate Contributions to Public Health at the Express Public Health Awards 2016. What are the plans for this project in the next two years? How do you plan to scale it up? The Asara project in Araku (Andhra Pradesh) is the flagship project of our NGO which is fully funded by the Piramal Foundation. The uniqueness of this project lies in the fact that it is an outreach programme to provide comprehensive integrated mother and child care in extremely difficult areas of habitation in the tribal belt. Currently, our team of paramedics cover about 180 habitations on motorcycles and on foot to reach the last mile through dense forests and mountains to serve the tribal communities in Araku mandal. Paramedics are provided with tablets for registeration and maintaining electronic health records. They are equipped to conduct field level diagnostics, identify high risk pregnant women and recommend cases for specialist consultation through the telemedicine centre established by us. Our intervention in the last few years has positively influenced the causes of morbidity and mortality in pregnant mothers and reduced the maternal and infant mortality to almost zero

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level. We intend to scale up our model to the neighbouring mandals which are inadequately equipped with maternal care facilities and have higher maternal mortality rates. In the next five years, we plan to reach about 5000 + pregnant mothers requiring antenatal care for facilitating safer deliveries and reducing maternal and infant mortality. What is the model used for deploying this project? How do you measure its efficacy? Asara Tribal Health Program is an integrated model focused on reducing maternal mortality rate (MMR) and infant mortality rate (IMR). It comprises an outreach programme, specialist consultation through telemedicine centre, diagnostics, counselling service, distribution of medicines and transportation of pregnant women. Paramedic staff are trained to counsel and develop health seeking behaviour in the tribal population besides building relationship/networks with the ASHAs/ANMs, anganwadi workers and community leaders. Group behavioural communication sessions are held to educate them on healthy practices to be followed during and post pregnancy. High risk pregnancy cases are identified

In the next five years, we plan to reach about 5000+ pregnant mothers requiring antenatal care for facilitating safer deliveries and reducing maternal and infant mortality

for special care. Referral cases are transported to telemedicine centre, where they receive the specialist consultation. The emphasis is on ensuring that all pregnant ladies go through minimum three antenatal checks leading up to institutional delivery. We have succeeded in identifying and managing 2000 + high risk cases over a period of five years. Our sustained efforts and commitment has increased institutional deliveries from 18.53 per cent to 61.09 per cent. Out of 61.09 per cent, 97.1 per cent of these women have delivered healthy babies with weight >2.5 kg (at birth) with no maternal deaths in the last two years. All these indicators are very encouraging and describe the efficacy of our programme. Which are the other projects handled by Piramal Swasthya in the public health space? Which state governments/ government organisations are you partnering with for these projects? We are running various health service lines in India in partnership with the state governments under the PPP model. These are health information helplines (universally accessible health information by a phone call), telemedicine services

(connecting patient to specialists in remote locations), mobile medical units (MMU), medical van services to interior villages and primary health centres (PHC). As on date we have presence in 11 states and partnership with state governments in nine states (Assam, Arunachal Pradesh, Jharkhand, Chhattisgarh, Maharashtra, Himachal Pradesh, Rajasthan, Andhra Pradesh and Karnataka) for running various health services. Besides this, we are also partnering with international NGOs and public/private and MMU-based health service under the CSR initiative with the public/private sector What are the major challenges in the Indian public health space? How does Piramal Swasthya playing a role in mitigating some of those gaps? Increasing population, rising life expectancy, increasing burden of non-communicable diseases and higher costs for medical care pose big challenges in the public health space in the country. At over eight per cent GDP growth in recent years, India is one of the fastest growing economies in the world in terms of GDP and is expected to be the third largest economy by 2050, but Indiaâ&#x20AC;&#x2122;s total expenditure in healthcare as a percentage of

STRATEGY its GDP is still one of the lowest in the world. Lack of a holistic approach, absence of linkages with collateral health determinants, inadequate infrastructure and human resource especially the doctors, lack of commitment, accountability and financial muscle are some of the challenges in Indian public health space. Piramal Swasthya brings in commitment, dedication and determination to deliver at the last mile despite challenges. We leverage on Information and Communication Technology (ICT), use telemedicine to facilitate the provision of specialist care reaching remote corners of our country, reduce beneficiary out of pocket expenses and their footfall. Above all, it is our strong commitment, belief and passion towards the cause of delivering quality health services to the most underserved people of our country. Since 2007, Piramal Swasthya has served 67 + million people in the country, providing primary and preventive care through various health service lines. PPPs in healthcare have seen mixed success in India. How has the PPP model worked out for Piramal Swasthya? Based on your experience, what can be done to create more workable synergies between public and private stakeholders in healthcare? The delivery of quality healthcare is a universally complex and challenging task. By our commitment,

credibility and quality of service we have successfully built synergies with various state governments. However there is a need for state governments to undertake Information, Education and Communication (IEC) activities more extensively for full optimisation of various health services provided by the state through the PPP model. States must also involve participation of communities and facilitate linkages with health workers like ASHA and ANMs for better co-ordination and monitoring of pregnant ladies and neonates. The big sore point in working with the state government is non-clearance of bills in a regular and time bound manner. The billing cycle in most cases is on a quarterly basis and realisation of the same on an average takes up to 45 days. This implies that there is a requirement of huge corpus to

Asara project provides comprehensive integrated mother and child care in the tribal belt

sustain operations for four to five months without any realisations from the state. Besides this, there is a lot of documentation to be put up with our invoices which makes it cumbersome. Much of our effort goes into collecting receivables instead of focusing totally on beneficiaries. The states must devise systems to address this problem realistically. A provision should be introduced to make advance payment up to 50 per cent in

the beginning of the billing cycle to the service provider. Any new projects in the offing? If yes, please elaborate on them. Our new projects are as follows: Integrated Software Application: In Telangana, a proof of concept (POC) is being tried out for an integrated software application in which a unique identification is created for each beneficiary. This data

is uploaded on the server and is available at multiple service points e.g. MMU/telemedicine centre/PHC. The beneficiary can appear either at MMU/PHC/tele-medicine centre however his electronic health record (EHR) will be available at all service points. Beneficiary will be tracked based on the unique identification number at any of the service platforms. This will ensure better tracking of pregnant women and noncommunicable diseases cases. Saturation model in Karnataka: In Karnataka, a saturation model has been proposed where Piramal Swasthya will be made responsible for the complete health apparatus of the state at the primary level in a limited area of a mandal/taluk. All the health services e.g. MMUs, telemedicine centre and primary health centres in that area will be managed and monitored under our supervision to capture hundred percent pregnant women and NCD cases. Leveraging technology and introducing efficient protocols in running various service health lines in the limited area and population, our intervention is expected to bring in more efficiency and accountability which can be assessed with impact measurement over a period of time. Both the above POCs are going to be replicable and scalable once the results are measured in terms of reduction in MMR, IMR and NCD cases. lakshmipriya.nair@expressindia.com

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Attention to proper ergonomics can reduce risk of injuries within a healthcare set up Swapneel Nagarkar, Senior VP - Marketing & Sales (B2B), Godrej Interio speaks to Raelene Kambli on how ergonomics in healthcare can help in achieving significant positive results such as improving productivity within hospitals and creating better healing environments for patients How can ergonomics be applied in a healthcare set up? In an healthcare set-up there are two broad categories – healthcare providers and patients. Healthcare providers often face the risk of musculoskeletal disorders (MSDs), caused largely due to overexertion and straining of muscles during patient handling activities. As far as the patients are concerned if they are not handled properly by caregivers, then the patients will also be prone to the risk of musculoskeletal disorders in the long run. What starts off as a simple pain, tingling or stiffness could lead to a serious medical condition. When the patient is being moved in the hospital, for instance while he/she is being lifted from his bed and put on a stretcher taking him to the operating theatre, if that movement is not done smoothly then the patient could develop some other issues, typically an orthopaedic issue at a later date. Careful attention to proper ergonomics can reduce the risk of injuries within an healthcare set up through increased staff effectiveness, productivity, improved patient safety and overall healthcare quality. How does it help to increase productivity among healthcare workers? Productivity is linked to physical well being of a caregiver and I believe that this can be guided by ergonomics. By definition, the word ergonomics means

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interaction between the user, that is, the employee and the workspace. Now, if we’re able to train healthcare providers in the area of ergonomics, then they can be guided about the right postures to take, the right kinds of body movement to be done when they are engaged in the different activities of their job etc. Some of the healthcare givers’ roles may be very indirect – like the purchase department or administration department in the hospital. But even these people, by virtue of their work profile, can be be trained in ergonomics for the right sitting postures or the right angles to place their laptops or computers from an office setup point of view. Ergonomics helps reduce injuries and occupational hazards while concentrating on how to create the right balance between the user (employee) and his elements of space (workspace). The healthcare givers who are directly in touch with patients need to be trained differently in terms of how to move the trolley, how to handle different medical equipment thereby making caregiving more ergonomical. If the caregiver is comfortable at work then absenteeism and frequent breaks go down. Simply put, reducing unnecessary or awkward postures and exertions reduces the time it takes to complete a given task, thus improving productivity. Any healthcare set up which is sensitive to ergonomics will surely provide better care. Any available stats on the

Ergonomics helps reduce injuries and occupational hazards while concentrating on how to create the right balance between the user (employee) and his elements of space (workspace)

same? It has been documented by various researchers that in organisations which do-not have a structured/planned employee health and productivity improvement plan in place, especially in terms of ergonomics, there is an adverse impact on employee health. The latest research done by our Ergonomic Cell suggests that ~71 per cent of employees are affected by MSDs in offices today. It reveals that currently seven out of 10 people in today’s highly computerised workspaces/job profiles complain of such health issues. While these begin as small irritating niggles, ignoring them results in chronic problems called MSDs. How will this concept provide better healing environment to patients? If you take the journey of the patient, from the time he enters hospital to the time he leaves it, he is subject to a host of movements. If he is in a bad condition he will be brought in on a stretcher or a trolley and if he’s in a reasonably good condition he may come walking. In either of the scenarios, if the healthcare facility becomes sensitive to ergonomics then the complete movement of the patient will happen ergonomically. In the case of patients who are in a position to sit and move by themselves, the kind of furniture that will be provided will be ergonomically correct so that they don’t end up

straining their backs. In turn, the entire experience of the patient will be such that his physical body will not face any discomfort, apart from the ailment he is suffering from unfortunately. Thus the overall environment becomes more healing for him. How many hospitals in India have started applying ergonomics in their facilities? We have been connecting with hospitals for more than a year with this particular initiative. Our experience has been that very few hospitals are actually practising ergonomics in their facilities. In terms of a specific number, it would be wrong on my part to comment because we haven’t surveyed all the hospitals in the country. But, we have connected with about 60 to 70 hospitals in the last one year and spoken to them about the programmes we undertake related to ergonomics and wellness. The response has been excellent. Most of them were honest enough to share that they have not been taking up these kinds of activities in a structured manner. We know of a few hospitals, maybe four or five hospitals in the country, that have started independently taking actions to make their hospitals ergonomically better. However, when we contacted those approximately 60 hospitals, the response has been overwhelming. Even in the course of the last six to eight months we have conducted Continued on page 56

KNOWLEDGE INSIGHT

Otorhinolaryngology and tuberculosis Dr Stephen Antony, Director, Divine Medical Centre and Dr Monica M Michael, ENT Surgeon Divine Medical Centre, Bengaluru elaborate on the various forms of TB and its manifestations TUBERCULOSIS, A communicable disease caused by the Mycobacterium tuberculosis, has the potential to affect any tissue in the body causing mass lesions and loss of function. It can manifest from a localised lesion to systemic, disseminated TB. Treating TB is imperative as it is a progressive disease and remains a major global public health problem. It is estimated that about one-third of the world's population is infected with TB. In India, it was earlier thought that TB was more common in the lower socioeconomic sections of the population. But, recently its incidence is rising in affluent society also due to increase in immunocompromised states like diabetes, chronic kidney disease, heart disease and increased prevalence of HIV etc. The various challenges in the control of TB are attributed to increased poverty and drug addiction, lack of TB chemotherapy, development of resistant strains, immigration from TB-affected areas, and decreased immunisation coverage. Ear, nose and throat (ENT) localisations of TB are also increasing due to these risk factors. Hence, it is also vital for otolaryngologists to keep an open mind and evaluate the condition extensively in case of doubtful cases, while diagnosing. Types of TB: Primary TB occurs during primary infection, evolving from pulmonary focus or by haematogenic dissemination. From primary infection, approximately five per cent of the infected cases can develop the active disease. While pulmonary TB is the most common presentation, extrapulmonary TB (EPTB) is also an important clinical problem. This includes tuberculosis of organs

presents with change of voice, causes ulcerative lesions, turban epiglottis and mouse nibbled vocal cords. It can involve the entire larynx. It can be diagnosed by direct laryngoscopy and biopsy. The treatment for it is with ATT.

Acid â&#x20AC;&#x201C; Fast Staining of M. tuberculosis

Cervicofacial Lymphadenitis

ENT manifestations of tuberculosis S.No Nature of the lesion

Percentage (%)

Tubercular cervical lymphadenopathy

Tuberculous laryngitis

8.30

Tuberculosis of cervical spine with retro pharyngeal abscess

6.8

Nasal TB

2.9

Tuberculous otits media

1.96

Various challenges in TB control are increased poverty and drug addiction, lack of TB chemotherapy, development of resistant strains, immigration from TB-affected areas, and decreased immunisation coverage other than the lungs, such as lymph nodes, abdomen, genito-urinary tract, skin, joints and bones, meninges, etc. Though ear, nose and larynx involvement in TB is relatively rare, they pose significant clinical and diagnostic challenge being the most common among the granulomatous infections. They are generally clinically primitive forms and typically affect young people with a slight prevalence among females. TB of ear, nose, throat

(ENT): TB affecting the ear, nose, throat region presents in the form of tuberculous cervical lymphadenopathy, laryngeal TB, tuberculous otitis media (TBOM) and nasal TB. Cervical lymphadenopathy: The otorhinolaryngeal manifestation of TB is most commonly cervical lymphadenopathy which presents as a neck swelling and may progress to suppuration forming a cold abscess. Fever if present, is of low grade. It can

Laryngoscopy demonstrating extensive and erythematous epiglottis with extensive polypoid changes most consistent with laryngeal TB or lymphoma

Aural TB

be diagnosed with fine needle aspiration cytology. In early stages it can be treated with antitubercular drugs (ATT), and in later stages non-dependent incision and drainage can be done. Laryngeal TB: The second most common manifestation is laryngeal TB and it usually is secondary to pulmonary TB. Patients suffer from dysphonia together with clinical outbreaks related to the pulmonary localisation. It

Nasal TB: The nose is least liable to invasion by acute TB of any part of the respiratory tract, because of the structure of mucosa, respiratory movements of the cilia and bactericidal secretions. Nasal TB can be due to direct inoculation or haematogenous spread. It presents as three entities - nodular form (lupus vulgaris), ulcerative form or sinus granuloma. Lupus vulgaris is the most common form. It is caused by direct inoculation, involving the skin and mucosa, with nodules (apple jelly nodules). Ulcerative form presents with ulcers over the cartilaginous part of the nasal septum, presenting with nasal obstruction and may progress to septal perforation. Sinus granuloma presents with a mass in the paranasal sinuses. TB in oral cavity: Involvement of oral cavity is a rare entity. Predisposing factors for primary oral TB include poor dental hygiene, dental extraction, periodontitis and leukoplakia. It presents with painless irregular ulcers over mucosa anywhere in the oral cavity. The site commonly involved is the tongue, followed by palate, gums and lips, whereas tonsillar TB is a rare localisation. It is crucial to exclude malignancy. The management involves confirmation with biopsy and ATT. Aural TB: Aural TB is a very rare disease entity. Modes of spread are nasopharyngeal spread through eustachian

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KNOWLEDGE

Oral TB

tube into middle ear or haematogenous spread. It presents with chronic serous/ blood stained painless otorrhea, otalgia and conductive hearing loss. Multiple perforations in the tympanic membrane is considered the hallmark of the disease. Pre-auricular adenopathy with postauricular fistula pathognomonic for tuberculous otitis media. It is evaluated with aural swab, HRCT temporal bone and treated with ATT. In case of intracranial complications or mastoid abscess, surgical intervention is required.

Symptoms and diagnosis of ENT TB: The characteristic features of TB are low grade evening rise in temperature, night sweats, weight loss, chronic cough and hemoptysis. But very few patients have

the presence of these classic symptoms. Hence, the presence of pulmonary TB should be evaluated in any case of doubt. Emphasis should be on chronic ear discharge, persistent swelling in the neck. General physical and local ear, nose and throat examination need to be carried out on all the patients. In addition to routine investigations, all the patients need to be subjected to chest X-rays. Radiological examination of the soft tissue neck, cervical spine and the mastoids should also be carried out. Endoscopic examination will include nasopharyngoscopy, direct laryngoscopy and bron-

choscopy. Histopathological examination not only helps a clinician to reach a definitive diagnosis and further management but also aids in documentation for medicolegal purposes. Fine needle aspiration cytology will be useful on suspected neck swellings. Investigations like culture and sensitivity and AFB staining of the sputum, pus from discharging sinuses, laryngeal secretions and ear discharge should be included. It is essential for the general population to be aware of the symptoms of TB in various regions and present early to the out-patient department. Early diagnosis is of prime im-

portance in TB otolaryngology as it saves time, energy and expenses for the patient and helps in starting appropriate management. Early management is mostly medical with anti-tubercular drugs. Surgical management is required only as a last resort in some conditions like the presence of abscess or as a part of diagnostic procedure. References Nasopharyngeal tuberculosis, Col R.K. Mishra, Col B.K. Prasad, Maj Sunil Mathew, Medical journal armed forces india, Elsevier 71(2015) S586eS589. Primary Nasal Tuberculosis Revisited: Case Reports,

Manish Chandra and *Rajeev Krishna Gupta, Indian Journal of Medical Case Reports, 2015 Vol. 4 (2) April-June, pp.33-35. Laryngeal Tuberculosis: A Rare Case Report, Yadlapalli AK, Veeranjaneyulu P, Krishna SB,Haseena Md, Mahajan A, Laryngeal Tuberculosis: A Rare Case Report. J Pharm Biomed Sci 2014; 04(06): 497-501. CASE STUDYEXTRANODAL ENT TUBERCULOSIS, Dr. D. Sridhara Naryanan1* and Dr. Dhanya T2, Dr. S. Anusha, World Journal of Pharmaceutical Research, Volume 5, Issue 01, 1376-1381

Continued from page 54

Attention to proper ergonomics... about six to eight wellness camps in these hospitals. Is Godrej researching on the concept of ergonomics and its uses in healthcare delivery? Yes! Godrej Interio proposes solutions fit for both, patients and caregivers, including ergonomically designed equipment, ergonomic training to caregivers and work practices to ensure a soothing patient experience. Godrej Interio is closely

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associated with ergonomics through its Wellness@Work Initiative. We are the pioneers in this space and amongst the very few companies in India who is driving awareness, correction and prevention of occupational hazards since 2009 in the office industry and 2014 in the healthcare industry. We formed the Ergonomics and Workspace Research Cell in 2009 which caters to this space. It has been documented by various researchers that

organisations do-not have a structured/planned employee health and productivity improvement plans in place and specially related to ergonomics and its impact on employee health. Our objective is to cater and partner with various organisations and reduce ergonomic hazards at workplaces. We also aim to help improve productivity, employee wellbeing and patient care in the healthcare industry through its awareness, assessment

correction and prevention approach (ACP). We have already covered 10 hospitals under this programme in this year and plan to increase our coverage in the coming year. Plans are to cover at least five to six hospitals with wellness programmes every month in the coming months. What is Godrej's strategy to engage more hospitals in applying ergonomics within their set ups? We are following a three

pronged approach: 1st level: Creating awareness about improving employee health and productivity through ergonomics awareness workshops 2nd level: Conducting ergonomic audits in the premises 3rd level: Certifying wellness champions within organisations through wellness certification programmes. raelene.kambli@expressindia.com

IT@HEALTHCARE I N T E R V I E W

‘Our focus is to make healthcare more accessible to the poor and oppressed’ Vivek Singh, Technical Architect, ThoughtWorks, outlines his company’s plans for the Indian market, the opportunities and challenges in the Indian healthcare IT space, their products to improve the public health sector in India and more, in conversation with Lakshmipriya Nair As a global software firm, how is the Indian market different from the other countries of the globe? The domestic and commercial market in India for software services was predominantly focussed on buying packaged software until a few years ago. We are seeing that trend changing towards digital strategies, something that’s quite prevalent on the global front. The work ThoughtWorks is engaged in with the local market can be broadly classified into three areas: ◗ Where companies are building new channels of engagement with their customers and creating new experiences ◗ Where companies, leading in their space, have challenges in scaling solutions or enhancing core capabilities ◗ Where companies who have invested in software packages want to ‘squeeze’ value from investments The other ways in which the Indian market differs from the global market are listed below. ◗ India, predominantly remains a cost-conscious market to date ◗ IT is still looked at, as a commodity play. Atleast for some if not most businesses. ◗ Custom software development and management require Indian technologists groom themselves in a specific set of niche development skills ◗ The choices available to consumers combined with economic changes see

companies re-evaluating their growth strategies ◗ The mobile-first generation of India is entering the workspace making organisations to rework their their IT systems and policies ◗ The rise of the Indian unicorns in the start-up space is shaking up industry domains When it comes to public health, ThoughtWorks believes in the advantages that open source products bring to the space. The challenge, here, comes in the form of an invalid perception that open source also means ineffective, poor quality, limited support and unreliable. This is not the case in some other countries and could be a reason for slow adoption of open source products within the public health space. How has the healthcare IT space evolved in the last 15 years, especially in India? The overall IT industry has evolved dramatically over the last 15 years, with digitisation and customisation taking centre-stage. Organisations have moved from single applications for specific tasks, at the lowest cost point to using integrated suites of products. This change is a new phenomenon and at a nascent stage within the public health industry. Today organisations are slowly, even hesitantly moving towards integrated management information systems. These are systems that incorporate billing, pharmacy and lab processes.

ThoughtWorks Global Health team contributes to a suite of products that make IT in healthcare services both, affordable and accessible

There is a curiosity revolving how IT could support patient care, as well. For example, the latest conversations are around PHRs or personal health records, where patients receive a simplified view of their records. National and regional governments are gradually investing in expanding the depth and complexity of health information systems, which gather both aggregate and transactional information in order to understand and react in a timely fashion to what is happening in the overall health system. Tell us about the products that you create for public health organisations in India? How will they help make public health more accessible, equitable and efficient? The ThoughtWorks Global Health team contributes to a suite of products that make IT in healthcare services both, affordable and accessible. Bahmni, an easy-to-use Hospital Information System and EMR, is a seamless integration of three critical systems: patient medical records, laboratory management and billing. Bahmni provides views of a patient's’ clinical summaries and reports. Healthcare needs to be accessible to those living in rural India, where the doctor to patient ratio is abysmally low. Bahmni enables these doctors to be more effective and provide better care.

How? Because Bahmni can be deployed with minimal knowledge of technology, if and when necessary. It has also been designed to operate efficiently in areas with limited bandwidth and infrastructure. ThoughtWorks is also building a Shared Health Record system (SHR) which allows public hospitals to share and exchange patient data. The primary objective of the information exchange is continuous integration, aggregation and communication of clinical information. This system will enable timely and consistent communication of diverse data between the entities patients, healthcare providers, hospitals etc, and facilitate analysis and decision-making. SHR aims to provide different benefits for various groups. From the standpoint of public health reporting or policy formulation, the health ministry will process patients’ clinical data to understand trends within a region or at national level. Also for funding purposes, administrators can view utilisation reports and analysis to improve efficiency and process optimisation. Doctors, researchers and practitioners can avail clinical decision support through patient data and timely reports. SHR also allows for integration with a national reporting system for dashboards like DHIS2, a flexible, web-based opensource information system

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April 2016

IT@HEALTHCARE with visualisation features including GIS, charts and pivot tables. The former integrates with any electronic medical record or EMR that follows standard protocols thus not requiring governments to spend on new systems but rather integrate existing EMRs. Our general approach is to support integrating systems. ThoughtWorks is an active contributor to OpenLMIS, a logistics management system for healthcare commodities. This platform helps track the availability and movement of medication and medical products across the organisation. It ensures that medication and medical products are available at any location, any time. ThoughtWorks has worked on Cycletel Hamsafar, an SMS-based family planning tool, empowering women to own their destiny. We have also worked with Motech on a few of their mHealth suite of products. How cost-effective is your product, since making public health services in India more affordable is pivotal? ThoughtWorks has

designed Bahmni to be a costeffective solution for hospitals that don’t have big IT budgets. A few of the characteristics that enable Bahmni to be the economic choice for public health systems are listed below. ◗ Bahmni is an open source solution and carries no license fee ◗ Bahmni is highly configurable in order to meet the specific needs and workflows of the clinical environment. However, a majority of the configuration does not require software developers, and can be completed by a staff member with basic IT skills and minimal training. Ongoing modifications can be made autonomously, without having to seek assistance from software designers like ThoughtWorks. ◗ Bahmni is designed to be hosted on low-end and lowcost servers and does not require expensive hardware. Since Bahmni is web-based, it can be accessed from anywhere in the hospital by any computer with a browser. Which public health institutions in India use your products? How does it

help to streamline their operations? Bahmni, a ThoughtWorks product was conceived during discussions with Dr Yogesh Jain of JSS. Possible Health identified Bahmni as a system to help Bayalpata Hospital in Nepal to manage data collection and form a reliable and easily accessible database of patient information. The other places and hospitals in India where Bahmni is being used are Jan Swasthya Sahyog in Bilaspur, Society for Education, Action and Research in Community Health (SEARCH) in Gadchiroli, at Lok Biradari Prakalp at Hemalkasa and at The Banyan in Chennai. Further away, in Haiti, ThoughtWorks worked with Partners in Health to help the latter develop a world-class system, increasing hospital efficiencies and ultimately delivering a better level of service to patients. ThoughtWorks has been quite active in the global health space. We are in partnership with the Ministry of Health in Bangladesh where we’re implementing the SHR system across various

facilities in rural Bangladesh. The accessibility of patient records across public hospitals, clinics and community health workers that came from this implementation was listed as a key accomplishments for 2015 in their health bulletin. Additionally, ThoughtWorks used the OpenLMIS platform to build a customised solution for an international NGO who deployed the solution in multiple countries in Africa. This solution prevents outage of medical stock, manage medical inventory to ensure continuous availability of the medical products. What are your plans for the Indian healthcare market in the new fiscal? Our focus across the global and Indian markets is to make healthcare more accessible to the poor and oppressed and ThoughtWorks continues to strengthen technological solutions in that direction. We are constantly working on increasing our implementation capacity in India. This is because by augmenting our capacity to deploy open source products

we will directly impact open source adoption in a positive way. ThoughtWorks is also investing time and design into the development of a complete, open source healthcare suite with multiple products. Any significant tie-ups with the healthcare sector in the offing? ThoughtWorks partners with various organisations on a variety of solutions and in various capacities. For example, one of our technologists is currently on secondment as a technology consultant with a large international nongovernmental organisation or INGO to help transform their technology solutions. We are in conversation with national NGOs to collaborate with state governments and charitable hospitals to increase the impact of technology in public health. We are also active participants in discussions and strategic alliances with healthcare ecosystem players such as leading hardware and diagnostic tools. lakshmipriya.nair@expressindia.com

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TRADE & TRENDS

Meditech bags iF design award for Vertex Mammography Medical Device The award has been bagged by an Indian healthcare company for the first time

NOIDA-BASED startup venture, Innovation Meditech Pvt Ltd has won the prestigious international iF Design Award 2016 from Germany for Vertex Mammography Medical Device in Discipline Professional Concept. The award has been bagged by an Indian healthcare company for the first time. It shares the award with design firm Universal Designovation Lab LLP. These Indian companies were chosen for this award from 5,295 entries sent by 2,458 participants from 53 countries and evaluated by a jury comprising 58 international experts. The Design firm Universal Designovation Lab LLP is led by Indian designers, Bhavin R Dabhi (Head-Machine Design) and Bhagvanji M Sonagra (Head - Product Design). Manufacturing of the product is taken care of by GP Singh Shekhawat (Director) and Rajiv Agarwal (Director) from Innovation Meditech. The awards are a true acknowledgement of excellence, innovation and originality of Indian design. The iF Design Award Winner Logo signifies outstanding achievements in design. The iF Product Design Award was introduced in 1954 and is annually conferred by the iF International Forum Design. Every year iF attracts more than 2,000 product entries from around 37 nations, which are judged by renowned experts, with the best of them receiving an iF seal of outstanding design quality. The best of the best are awarded with an iF award, known as the ‘Design Oscar’. Singh collected the award at the iF design award night held on February 26, at BMW Welt

GP Singh Shekhawat, Director, Innovation Meditech

in Munich, Germany.

Jury statement about Vertex Mammography Vertex Mammography is a specific type of imaging that uses a low-dose X-ray system to examine breasts. Doctors can use this device easily and effectively. This product is designed for all women so it has the best height adjustment features. The product's aesthetics are rich and trendy. The device colour is a blend of lime green and white. The intention of using these colours in a medical device is to provide a feeling in the female users that they are healthy and lively. The USP of the product is its ability to adapt to its own dimensions.

About the product What is Vertex Mammography used for? Vertex Digital mammography, is a mammography system in which the X-ray film is replaced by solid-state detectors that convert X-rays into electrical signals. These detectors are similar to those found in digital

cameras. The electrical signals are used to produce images of the breast that can be seen on a computer screen or printed on special film.

adjustment features and offers ease-of-movement. High grade ergonomics has been used to give maximum comfort to the user.

What problem does it solve? Vertex Mammography is a specific type of imaging system that uses a low-dose X-ray method to examine breasts. A mammography exam also known as a mammogram is used to aid in the early detection and diagnosis of breast diseases in women with symptoms such as a lump, pain or nipple discharge.

What makes it special compared to its counterparts? Vertex Mammography has been designed for the use of all women. The product aesthetics are rich and trendy. The colour of the device is a combination of lime green and white. The intention of use of lime green colour in medical device is to giving feeling to the women user that they are healthy and lively. The product has an ability to become smaller or larger to suit its dimensions. So it offers space advantage. Its ability to compress and go up to its full length can be a vital design difference compared to the standard available for mammography.

What are the benefit for the users? Vertex Mammography provides accuracy in detection of breast cancers alongwith comfort. The device easy-touse and is highly effective. The product is designed for all women so it has the best height

About the company Innovation Meditech has a team of highly qualified and competent professionals that are headed by an adroit management. The organisation has high quality manpower with expertise and skills. It organises internal induction programs and trainings sessions, which facilitate the process of job rotation and quick career growth. The company’s dynamic, highly skilled and enthusiastic workforce toil hard to maintain excellence in the services they offer. A motivated team focuses on ensuring that each engagement meets the high standards of the company. The company plans to manufacture Vertex X-Ray Mammography at its facility in Delhi/NCR. The product will be available by in the Indian market by the end of 2017.

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TRADE & TRENDS

PSRI organises PSRICON-2016 in New Delhi The conference was conducted in collaboration with Indian College of Physicians (ICP) and Association of Physicians of India (API) PSRI HOSPITAL organised a CME in collaboration with Indian College of Physicians (ICP) and Association of Physicians of India (API), Delhi Chapter at India Habitat Centre, on March 20, 2016 in New Delhi. The programme was inaugurated with a lamp lighting ceremony by Dr Rakesh Tandon, Medical Director, PSRI Hospital; Dr Ajay Lekhi, President, Delhi Medical Association; Dr Anil Gombar, Chairman, API, Delhi Chapter; Dr Girish Tyagi, Secretary Delhi Medical Council; Dr MPS Chawla, Secretary General, API Delhi Chapter; Dr Sanjiv Saxena and Dr Manoj Kumar of PSRI Hospital. Dr Rakesh Tandon emphasised that all specialists should train and practice as physicians first to ensure placing their speciality management in the correct perspective. Thus, continued interaction between specialists and internists /physicians is necessary. Sunanda Singhania, Executive Director, PSRI Hospital informed that over the last few years PSRI had already converted itself from two speciality-focused hospital to a multispeciality hospital. By July 2016, a whole new building with nearly additional 100 beds and five operation theatres will be added to the existing hospital building. With that becoming operational, additional facilities like cardiac care, liver transplantation, bariatric surgery and arthroplasty will also get established in PSRI. The programme was attended by top medical professionals of Delhi NCR, who discussed the recent technological and pharmacological developments in healthcare. Some major issues discussed included obstructive sleep apnea, current approach to management of diabetes, management of backache, ABO incompatible kidney transplantation, nephrotic syn-

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drome in childhood, pain management, oral drugs therapy for chronic Hepatitis C, Therapeutic Endoscopy and Endoscopic ultrasound (EUS), G.I Manometry and pHMetry.

About PSRI Hospital Pushpawati Singhania Research Institute (PSRI) is a leading hospital dedicated to provid-

By July 2016, a whole new building with nearly additional 100 beds and five operation theatres will be added to the existing hospital building

ing advanced and comprehensive medical and surgical treatment for Digestive Diseases, with core specialisation in the areas of liver, kidney, gall bladder, pancreas, gastrointestinal tract. Liver, renal and digestive diseases are highly prevalent all over the world, adding significantly to the high death rate.

TRADE & TRENDS

Innovative technology of printing medical images on plain paper! With one of the most promising innovation in medical imaging, Ricoh’s DICOM plain paper print solution offers a high quality and affordable solution for printing medical images

WILHELM ROENTGEN’S discovered X-rays in 1895. The medical imaging experienced digital revolution with advent of computer-based image processing in 1970s. And then we witnessed the transition to a unified imaging platform with the introduction of DICOM and PACS in 1993. DICOM enables the integration of scanners, servers, workstations, printers and network hardware for multiple manufacturers into PACS. Ricoh India seems to have taken the next step in this development timeline by launching an innovative printing solution that can print medical images from different modalities such as XRay, CT, MRI, etc., on plain paper, replacing the conventional films. This medical image plain paper printing solution has helped organisations to bring down cost of care delivery. The hospitals and diagnostic centres are now reducing their costs by adopting this innovative solution. This solution has also helped healthcare sector to avoid use of harmful plastic films that are non-biodegradable and is a heart of environmental crisis. Puneet Kanodia, COOHealthcare, Ricoh India said, “In the past one year, our DICOM plain paper print solution has been embraced by doctors. The quality of the paper prints have been appreciated by doctors. Since our solution is being offered on a subscription model, there is no capital expenditure and even stand-alone diagnostics centres are adopting the technology. The solution is cost effective and our customers have been enjoying savings more than Rs six lakhs a year.”

Puneet Kanodia, COO- Healthcare, Ricoh India

Five years back, the ultrasound images were also printed on films. Now, all ultrasound reports are being printed on plain paper. Analogous to ultrasound images, DICOM images will also be printed on plain paper in the years to come. Several leading hospitals and diagnostics centres in key cities like Delhi, Mumbai, Kanpur, Ahmedabad, Pune, etc., have been using the solution and have been satisfied with the quality of the paper prints. The solution consists of both hardware and software. The software is installed on a mini computer gets it fetches DICOM images from the digital modality. The software orders paper prints on Ricoh’s medical printer. The solution has a streamlined workflow, where the print can be ordered directly from the workstation and no separate training is required to use the solution. The life of the DICOM image print is over 10 years and can be easily documented along with prescriptions and other lab reports. In addition to the DICOM plain paper print solution, Ricoh offerings include PICASSO,

Ricoh India's solution has also helped healthcare sector to avoid use of harmful plastic films that are non-biodegradable and is at the centre of an environmental crisis which stands for Patient Is Central to this Advanced Solution and Service Offering – a stateof-the-art PACS and tele-radiology solution. PICASSO is also being offered at a subscription model. All the patient medical images will be pushed to a cloud server that can be accessed anytime with all the desired encryp-

tions and security standards. There is no more need for a hospital/diagnostic centre to maintain a server to store old patient reports. The application has a provision to provide access to their patients. Since the application is a browser-based application, medical images can be viewed on any device – worksta-

tion, laptop, tablet or mobile. Ricoh also provides medical grade monitors used for viewing medical images and digitizers for scanning old plastic films and converting them into DICOM images. With such an exhaustive range of offerings, Ricoh is indeed a one stop shop for all imaging technology needs.

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TRADE & TRENDS

Hospitality in Hospitals Dr J Sivakumaran, COO, KMCH Coimbatore, speaks about the importance of hospitality within healthcare set-ups and elaborates on the various aspects to be considered

HOSPITALITY is basically developing a relationship between a guest and a host. In the relationship process a stranger becomes a guest, a friend and finally a loyal customer. Hospitality and hospitals have similarities in many functions. Like hotels, hospitals also strike a relationship with their patients and the service providers. Patients get admitted, treated, cured and becomes a customer for his future healthcare needs. In both the places the customer spends time and money for the services availed. In both the activities, the basic principle is to create a culture of treating customers respectfully, ethically to ensure customer satisfaction which could be measured and reviewed. The support services like F&B, housekeeping, engineering, laundry, room services, billing, HR, security, sales and marketing are common in both the sectors. In these sectors response time, soft skills, dress code, proper communication with the guests, ambiance, interiors, proper housekeeping and food services are elements of satisfaction index. Satisfaction based on experience of the services is the prime deciding factors for revisit. If service is not up to the mark or the experience is not pleasant, customer will choose an alternate service provider. Unlike product selection, the decision of choosing services is not only done by the customer himself but also influenced by friends, relatives, and peer groups. One major difference is that the state of mind of customers and relatives are different in healthcare and hospitality industries. The choice of food could be at the guestsâ&#x20AC;&#x2122; wish in hotels, whereas the choice of food is either limited or chosen by dieti-

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cian in hospitals. In hotels, people wish to stay leisurely as tourist guests, but in hospitals, no body wish to stay as a patient guest. Levels of hospital service: We can divide hospital services into three levels. The first level is the core clinical service level in which innovations in service delivery are limited. The second level is the mixture of clinical and non-clinical services like patient safety, quality service, functional design, protocols etc. Here the scope of innovation is better than the first level but limited. The third level is the non-clinical level which really swings patients' experience from one side to another. Housekeeping, F&B, soft speaking service providers, response time, waiting time etc., come under this level. Unlimited innovations could be done in this level. Hospitals are borrowing many concepts from hospitality sector to meet the expectations of the patients at this level of services. Adoption of Hospitality Designs: Hospital experience is not only based on clinical out-

Dr J Sivakumaran COO, KMCH Coimbatore

comes, but also based on numerous other minute observations and interactions encountered by the patients in the hospital. Apart from the doctor being nice to the patient, the response time, timely supply of food, usage of latest equipment, technical knowledge of the service provider, waiting time, transparency in billing, upkeep of the usage area, cleanliness of the bed and washrooms etc., also play a vital role in patient experience. Most of these are applicable to the hospitality in-

dustry as well. A scientific evaluation suggests that for a healthcare environment, aesthetically designed natural elements or sceneries is preferred to reduce the stress and generate positive thoughts in the minds of the patients. The incorporation of hospitality design makes patients and attendants at ease and reduces the anxiety of being in a new place and environment. Feeling at home will increase the comfort level of the patients and help to increase the recovery process. Many of the hospitality elements like spacious reception and tastefully designed furniture, decorative walls, attractive lighting with soothing music etc. are adopted by the modern hospitals. Some of the corporate hospitals have sophisticated rooms better than star hotels. Rooms have kitchen, play area for kids, visitorâ&#x20AC;&#x2122;s lounge etc. To enhance the experience, hospitals have lavish lobbies, common spaces, spas, wellness-therapy centres, entertainment theatres, book shops, bank ATMs, flower shops, gift shops, wi-fi internet

Apart from the doctor being nice to the patient, the response time, timely supply of food, usage of latest equipment, technical knowledge of the service provider, waiting time, transparency in billing, upkeep of the usage area, cleanliness of the bed and washrooms etc., also play a vital role in patient experience. Most of these are applicable to the hospitality industry as well

services, branded food joints, yoga centres, travelling desks and so on. Adoption of Hospitality F&B: Food and beverages is an important department within hospitals. The trend of serving customised food to the patients is practice in hospitals. This is to take care of the patients' need. Therefore, every time the patient attendant need not shuttle here and there for food. The food menu is customised depending upon the patientâ&#x20AC;&#x2122;s ailment and progress. If the patient needs to be given liquid food for every two hours, arranging liquid food so frequently from outside will be a cumbersome process to attenders. If arranged from outside, the quality and hygienic preparation will be in question. If the quality is compromised, instead of improving, the patient will start deteriorating. Here again the hospitality industry has helped the hospitals to adopt the culture of preparing variety of customized menu depending upon the condition of the patients. Like hotels, the food is served by uniformed waiters, who have been trained in soft skills and manners, presented and served neatly on time so that the patient feels at home. The frequency and timings of serving may vary from hospital to hospital and within a hospital from one patient to another. For medical tourism patients, the menu will be totally different in terms of variety, preparation, taste and presentation. To handle the variety of patients, many of the executives from hospitality industry are being hired in the area of F&B, front office, housekeeping, guest relations etc. The demand for talents from these department is increasing.

TRADE & TRENDS

Sun Narula Group Healthcare automation SNG offers high speed full automated IP and OP pharmacy storage and dispensing solutions

SINCE THE foundation of the group in 1953, SNG aka Sun Narula Group has been extensively involved in bringing #SmartSolutions to the Indian healthcare sector. One of the verticals is Healthcare Automation, primarily offering world class and high tech solutions in the areas of materials handling & transport and hospital pharmacy automation. The idea of bringing these technologies is not to replace or substitute employees but to enhance healthcare facilities, reduce healthcare delivery costs, improve efficiency, recover and heal faster and improve healthcare delivery quality. Some of the #SmartSolutions are as follows: Imagine an IP Pharmacy in a hospital, it will require a space of around 400-600 square meters. Real estate is the most expensive part of any hospital and best space management is need of the hour. SNG’s AVSRS allows a fully automated vertical pharmacy storage and retrieval solution with similar storage space of 400-600 square metres with a foot print of only around 10 square meters, leaving the valuable space for other departments of the hospitals or even more patient care beds and other services. The solu-

tion with changes can also be applied for food trolley to wards, CSSD packages, fresh linen storage, retrieval & deliveries to different floor levels.Automated Hospital PharmacyToday in hospital IP pharmacy spaces, the major challenges faced are storage and dispensing of prescribed drugs per patient. Nurses at ward levels get involved in preparing exaction dosage for each prescription for patients consuming more than 40 per cent of their time in handling drugs. While in OP pharmacy, time consumed to read, pick and delivery is prescription reference order to the OP patients is huge. Some hospitals have

more than 3000 OP patients being handled – now imagine if each prescription takes around three to five minutes to dispense the order – for 3000 prescriptions it will take the OP pharmacy around 150–250 hours each day. In all reality, this is never achieved causing immense discomfort and frustration to the pharmacy operators as well as the patients. SNG offers high speed full automated IP and OP pharmacy storage and dispensing solutions to address these challenges.

Hospital pneumatic tube system SNG is South Asia’s leading

provider of hospital pneumatic tube systems since 2004 for safe-secured-swift transports of lab samples, blood bags, reports, drugs, cash, documents etc., and have reference of over 300 installations in the region with more than 70 per cent market share. Today SNG has complete in-house capabilities

right conceptualisation, designing, project management to post sales services dedicated for pneumatic tube systems with pan-region presence. SNG has also introduced some state of the art new stations – a first in the world by Swisslog – world leaders in healthcare automation solutions.

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TRADE & TRENDS

Modi Medicare introduces MedMammo an independent FFDM Mammography workstation Modi Medicare’s Med Mammo is a mammography diagnostic workstation which combines ease of use and high performance features. this mamography workstation enhances reading and image management. Breast imaging and women’s health clinics will benefit of Medecom’s 15 years of radiology and image workflow experience. With Medecom’s Med Mammo breast imaging workstation, you can include reading of tomosynthesis images and other multi-modality radiology examinations in your regular mammography reading workflow. This significantly increases efficiency as the need to move to a dedicated modality workstation is

eliminated. Med Mamo is among the first digital mammography solution to offer support for import and review of the tomosynthesis DICOM format. Multimodality with relevant Prior matching: Users benefit from Med Mammo’s multimodality support to pre-fetch clinically relevant priors including ultrasound, MRI and tomosynthesis, to be displayed side-by-side with the mammograms. Each imaging study is automatically associated with the corresponding modality imaging functions such as, measurements, stitching, MIP/MPR, and modality display protocols. This ensures

improved this critical element of digital mammography reading, to make it possible to view and report on all forms of breast imaging (MRI, ultrasound, digital breast tomosynthesis and X-ray) from any vendor on a single client interface.

that they are hung with the precise tools according to radiologists’ preferences for optimal viewing and diagnosis. Mammography Studies from multiple vendors are automatically scaled and aligned to ensure optimal side by side comparison. Medecom has

A complete Digital Mammography solution: In order to take full diagnostic advantage of the tomosynthesis format one needs to ensure the support of tomosynthesis images throughout the digital mammography workflow. This requires modules that complement legacy radiology systems to ensure compatibility or extend functionality offered by the new tomosynthe-

sis format. Medecom provides tomosynthesis support throughout a vendor neutral, digital mammography, product line. Medecom's digital mammography modules include storage, reporting, printing, CD/DVD archive and Electronic Image Exchange. Compliant with the regulatory requirements and standards in many countries, Med Mammo is a true alternative to any manufacturers' workstations. For more details, contact : JIGISH B MODI PH: 2506 5664, 98670 01110, email: modimedicare@gmail.com Skype: modi.medicare

Myrian XL-Onco: The solution for oncology follow-up THE UNIQUE solution for multimodality oncology follow-up Myrian® XL-Onco is the culmination of eight years of development of the Myrian platform. Dedicated to oncology follow-up, it manages the sequencing of tasks essential for the management of the cancer patients with elevated efficiency and in strict complaince with the international RECIST rules, consensually established by European, Canadian and American authorities. The Cheson protocol whose parameters can be set by the user are also available. Myrian XL-Onco was developed and validated jointly with leading French experts and makes Intrasense a world leader in oncology follow-up software applied to medical imaging. It is intended for routine clinical practices of hospital

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the software that considerably simplifies the radiologist's work

First rate partners The best specialised cancer teams contributed to the development of this module: ◗ Curie Institute (Paris, France) ◗ Pitié-Salpêtrière (AP-HP Paris Public Hospitals Authority)(Paris, France) ◗ Hôpital Européen Georges Pompidou (AP-HP - Paris Public Hospitals Authority)(Paris, France) ◗ Civil Hospices of Lyon (HCL)(Lyons, France) ◗ Montpellier University Hospital (Montpellier France)

treating cancer patients as well as pharmaceutical companies and CROs in the framework of phase I,II and III clinical trials to evaluate anti-cancer therapies.

Original Technologies Automated retrieval of prior exams, dedicated clinical workflow obeying RECIST rules, automatic 3D registrations of examinations in elastic mode, automated production of reports and graphs

Applications It is used to follow the course of a patient's cancer by com-

paring the latest examination to prior results. This follow-up involves key steps managed by

For more details, contact : JIGISH B MODI PH: 2506 5664, 98670 01110, email: modimedicare@gmail.com Skype: modi.medicare

www.siemens.com/somatom-scope

How can I save time and effort in my daily CT routine? Healthcare providers everywhere are under pressure to change. Budgets are decreasing, and the demand for highquality, and affordable, care is rising. To succeed, you must enhance process efficiency across the board. Streamline, focus on the essence, identify what matters. Siemens Healthcare enables you to do that â&#x20AC;&#x201C; with SOMATOM Scope. Scan preparation and image reconstruction workflows are often time-consuming, and prevent you from focusing on what matters: your patients. Integrated Fully Assisting Scanner Technologies (FAST) help save you time and effort throughout your daily routine. FAST Planning enables precise organ coverage without overscanning, and avoids rescans due to incorrect positioning.

FAST Spine delivers a complete spine reconstruction in just 30 seconds.* Optimum standardization increases reproducibility and reliability, boosting diagnostic confidence. Designed to improve your workflows, SOMATOM Scope supports you in delivering first-rate care to as many patients as possible. Because when it comes to your patientsâ&#x20AC;&#x2122; wellbeing, second best is not an option. *Data on file; compared with previous generation

For business queries, please email us at: hc_contact.india@siemens.com or you can call our Helpline: 1800-209-1800

Sanrad Medical Systems

REGD. WITH RNI NO. MAHENG/2007/22045, POSTAL REGD. NO. MCS/162/2016 – 18, PUBLISHED ON 8TH EVERY MONTH, POSTED ON 9TH, 10TH, 11TH EVERY MONTH, POSTED AT MUMBAI PATRIKA CHANNEL SORTING OFFICE, MUMBAI – 400001

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Toll Free No : 1800 425 9001 : 022-2600 6060 : 080-2837 6060 64 Slice CT Scanner

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Head Office: 1, Manek, S.V. Road, Santacruz (West ), Mumbai 400054, Phone: +91-22-26006060, 26494702 Regional Office: 108 E-2,3rd Phase,6th Main Road, Peenya Industrial Area, Bangalore 58,Phone:+91-80-28376060 Email: info@sanrad.in, sanradmedica@yahoo.com, Website: www.sanrad.in