Express Healthcare (Vol.11, No.2) February, 2017

CONTENTS Vol 11. No 2, FEBRUARY, 2017

Chairman of the Board Viveck Goenka

MR Elastographyof liver Arobust emerging technique

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Sr Vice President-BPD Neil Viegas

HEALTHCARE SABHA 2017: CO-CREATING A MANIFESTO FOR A HEALTHY INDIA

Editor Viveka Roychowdhury* Chief of Product Harit Mohanty BUREAUS Mumbai Sachin Jagdale, Usha Sharma, Raelene Kambli, Lakshmipriya Nair, Sanjiv Das, Mansha Gagneja Delhi Prathiba Raju Design National Design Editor Bivash Barua Asst. Art Director Pravin Temble Senior Designer Rekha Bisht Graphics Designer Gauri Deorukhkar Artists Vivek Chitrakar, Rakesh Sharma Photo Editor Sandeep Patil MARKETING Regional Heads Prabhas Jha - North Harit Mohanty - West Kailash Purohit – South Debnarayan Dutta - East Marketing Team Ajanta Sengupta, Ambuj Kumar, Douglas Menezes, E.Mujahid, Mathen Mathew, Nirav Mistry, Rajesh Bhatkal PRODUCTION General Manager BR Tipnis Manager Bhadresh Valia Scheduling & Coordination Ashish Anchan CIRCULATION Circulation Team Mohan Varadkar

Dr Parul S Garde, Consultant Radiologist, Global Hospitals, Mumbai, talks about new techniques revolutionising the diagnosis and management of chronic liver disease | P-36

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DENTAL HEALTH SECTOR IN INDIA – A SWOT ANALYSIS

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TMC HOSTS CONFERENCE TO CELEBRATE PLATINUM JUBILEE YEAR

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COLUMBIA ASIA HOSPITALS TIES UP WITH PDMD, CAMEROON

INTERVIEWS P10: JITENDAR SHARMA

P23: ABHIMANYU BHOSALE

CEO, Andhra MedTech Zone (AMTZ)

Founder, LiveHealth

P17: POONAM MUTTREJA

P24: CLAIRE BONILLA

Executive Director, Population Foundation of India

Chief Global Officer, Sight Life

P21: LOKESH SHARMA

P29: OM PRAKASH

Head, Public Health – Africa, Middle East, South Asia, QuintilesIMS

MANCHANDA

P22: DR FARHAT MANTOO

P35: ESTHER GOKHALE

Head of HR, MSF in South Asia

Creator and Founder, The Gokhale Method

Whole-time Director and CEO, Dr Lal Pathlabs

Express Healthcare® Regd. With RNI No.MAHENG/2007/22045. Postal Regd.No.MCS/162/2016-18. Printed and Published by Vaidehi Thakar on behalf of The Indian Express (P) Limited and Printed at The Indian Express Press, Plot No.EL-208, TTC Industrial Area, Mahape, Navi Mumbai-400710 and Published at 2nd floor, Express Towers, Nariman Point, Mumbai 400021. Editor: Viveka Roychowdhury.* (Editorial & Administrative Offices: Express Towers, 1st floor, Nariman Point, Mumbai 400021) * Responsible for selection of news under the PRB Act. Copyright © 2017. The Indian Express (P) Ltd. All rights reserved throughout the world. Reproduction in any manner, electronic or otherwise, in whole or in part, without prior written permission is prohibited.

EDITOR’S NOTE

Rebuilding trust

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quick read through the year end review of the initiatives and achievements of the Ministry of Health and Family Welfare is impressive. In fact, Union Health Minister JP Nadda has gone on record to say “that the past two years have witnessed a historic growth in the form of infrastructure and other facilities.”

He was speaking on the day India's premier public health institution, the All India Institute of Medical Sciences (AIIMS), New Delhi, signed three MoUs of a cumulative net worth of `7670 crores, which the Health Minister pointed out was the the largest ever health sector investment commitment made by the Government in a public health project at one event. His assertion that all new AIIMS will be “AIIMS” and not “AIIMS-like” is also very promising, because AIIMS-Delhi is definitely a centre of excellence but it is forced to cater to patients far beyond its capacity, due to the dearth of similar facilities in other states.

It will be quite a few years before the new AIIMS (spread across the country in Bhopal, Bhubaneswar, Jodhpur, Patna, Raipur, Rishikesh, Raebareli (Uttar Pradesh), Nagpur (Maharashtra), Mangalagiri (Andhra Pradesh), Kalyani (Bengal) become fully operational and acquire the reputation of AIIMS Delhi, but at least a start has been made.

A significant aspect of the MoH&FW's achievements is that it has chosen to invest time and efforts to tighten the infrastructure at existing public health facilities as well. And this initiative has already reaped rewards. A few significant early wins could push other laggards to move faster.

Last year, under the Biomedical Equipment Management and Maintenance Programme (BMMP), the Ministry set out to first map the inventory of all bio-medical equipment with the key aim of gauging their functionality.

The mapping was successfully completed in 29 states, covering more than seven lakh pieces of equipment, worth around `4564 crores, in over 29,000 health facilities.

Results from the 29 states where the mapping

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Closer monitoring and sprucing up of existing infrastructure will go a long waytowards rebuilding trust in India's public health facilities

was completed were discouraging. 13 per cent to 34 per cent of equipment was found to be dysfunctional. The cost of this dysfunctional equipment was estimated at a whopping `1015 crores. Which meant that about a fourth of the equipment was not available for public use, simply because the authorities had not got it fixed, for a variety of reasons.

The Ministry then prepared comprehensive guidelines and supported these states to redress the sorry situation, primarily by rolling out a tender process to outsource the maintenance of existing medical equipment.

Eleven out of the 29 states mapped out, (Andhra Pradesh, Kerala, Rajasthan, Mizoram, Chandigarh, Maharashtra, Sikkim, Madhya Pradesh, Punjab, Jharkhand and Puducherry) have now successfully outsourced equipment maintenance while three states (Tripura, Nagaland, and Arunachal Pradesh) have completed the tendering process and are reportedly at the implementation stage.

Five states (Uttar Pradesh, West Bengal, Chhattisgarh, Karnataka, and Gujarat) are in the process of finalising tenders, while the remaining ten states are yet to get off the block.

The 12 states where work orders have been already been issued have already seen promising results: dysfunctional equipment costing `378.11 crores became functional four months from the time the work order was passed. Even better, there has been a reduction in the equipment break down rate by about 25 per cent. Downtime of three to four months has reduced to maximum downtime of seven days, which means that equipment is being repaired faster.

While the new AIIMS might seem like a distant vision, closer monitoring and sprucing up of existing infrastructure will go a long way towards rebuilding trust in India's public health facilities. We hope to discuss and deliberate on more such policy initiatives at Healthcare Sabha, from February 9-12. We'll be back with key takeways from the conference in our March edition.

VIVEKA ROYCHOWDHURY Editor viveka.r@expressindia.com

LETTERS QUOTE

JANUARY 2017

One of the most historic days for AIIMS as this is the largest health sector investment commitments ever made by government in a public health project at one event

JP Nadda Check out the online version of our magazine at

www.expresshealthcare.in

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Board line: 0120-6651500.

Union Minister for Health and Family Welfare, at an event where an MoU was signed between AIIMS with NBCC (India), HSCC (India) and HITES HLL Life Care in New Delhi

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Amid a global shortage of injectable inactivated polio vaccine (IPV), countries in the WHO South-East Asia Region are opting to use fractional doses of IPV, an evidence-based intervention that not only ensures continued protection of children against all types of polioviruses, but also helps save vaccine – a move bound to positively impact global vaccine supply in the coming years

Dr Poonam Khetrapal Singh WHO Regional Director for South-East Asia

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February 2017

MARKET PRE EVENT

Healthcare Sabha 2017: Co-creating a manifesto for a healthyIndia The event will be held at Visakhapatnam from February 9-12, 2017

W

ith an aim to drive a revolution and facilitate a dia-

logue in public health, Express Healthcare, a publication from The Indian Express

Group, launched Healthcare Sabha — The National Thought Leadership Forum

on Public Healthcare.

Healthcare Sabha 2017 will create a blueprint to fa-

cilitate evidence-based policy making, augment excellence in healthcare delivery and

CONFIRMED SPEAKERS

MANOJ JHALANI, Joint Secretary, (NHM Policy), MoH&FW, GoI

SUNIL SHARMA Joint Secretary, PMSSY, MoH&FW, GoI

DR BD ATHANI Special DG, DGHS, MoHFW, GoI

ALOK KUMAR Advisor, NITI Aayog

DR J RADHAKRISHNAN Principal Secretary-Health

DR DAMODAR BACHANI Deputy Commissioner NCDs, MoH&FW, GoI

KAVITA SINGH Director, NRHM-Finance, MoH&FW, GoI

RP KHANDELWAL CMD, HLL Lifecare

DR NAVJOT KHOSA MD, Kerala Medical Services Corporation

GYANESH PANDEY CMD, HSCC

DR KC TAMARIA Medical Superintendent AIIMS Bhopal

DR HEMANT KOSHIA Commissioner, FDC, Gujarat

DR DEEPAK AGARWAL Chairman, Computerisation and IT, AIIMS

DR PRATEEK RATHI Special Executive Officer, ESI Scheme, Dept of Public Health, Govt of Maharashtra

DR SULEMAN MERCHANT Dean, Lokmanya Tilak Municipal Medical College & Hospital

DR AVINASH SUPE Director and Dean, GS Medical College & KEM Hospital

DR ATUL KHARATE State TB Officer & Jt Dir Health Services, Govt of Madhya Pradesh

DR TATYARAO LAHANE Dean, Grant Medical College and JJ Hospital

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eliminate barriers to equitable access. Healthcare Sabha 2017 will work toward 'Co-creating a Manifesto for a Healthy India.' The event will be held at Visakhapatnam from February 9-12, 2017.

Key subjects at the forum include: Pillar 1-Tackling talent crunch: Improving capacity and competence ◗ Role of PPPs in training healthcare professionals. ◗ Strategies to attract doctors to public health (especially in rural India). ◗ An assessment of the Skill India Initiative and the way forward. ◗ Creating a large pool of efficient and skilled professionals. ◗ Medical education syllabus in India: In need of a major rehaul.

Pillar 2-Developing sustainable health financing systems ◗ Galvanising healthcare via insurance. ◗ Govt sponsored schemes: Meant for poor, but beyond their reach. ◗ Understanding health economics: A much needed remedy for a healthy India. ◗ Infrastructure essentials: Plan for an affordable healthcare system.

Pillar 3-Ushering good governance in public health ◗ Technology for good governance in public hospitals. ◗ Revisiting our disease control strategies: Successes & failures (NCD, Anti-TB programmes etc.) ◗ Strategies to mitigate health infrastructure deficit. ◗ Uprooting corruption from healthcare: An urgent need.

Pillar 4-Ensuring access to quality health services and essential medicines ◗ Analysis of Mohalla clinics (Studying the efficacy of the model and their replicability). ◗ Universal Immunisation Coverage: Making it Mission Possible. ◗ Medicines for all: Roadmap for better accessibility and affordability. ◗ Sanitation: Is the Swachh Bharat campaign taking us

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closer to a Swasth Bharat? ◗ Eliminating malnutrition: Taking a multi-pronged approach.

To be held concurrently with Healthcare Sabha, the Express Public Health Awards will honour Champions,

Visionaries and Game Changers in Public Healthcare.

The first edition (held from March 4-6, 2016 at Hyderabad Marriott Hotel and Convention Center) brought together significant stakeholders in public health to

deliberate on cohesive, unified and innovative ways to achieve the National Health Mission’s Vision pertaining to ‘Universal Access to Equitable, Affordable and Quality Healthcare Services to All’.

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I N T E R V I E W

Holistic approach towards Med Tech Jitendar Sharma, CEO, Andhra MedTech Zone (AMTZ) in an interaction with Prathiba Raju, shares that the upcoming maiden med tech zone in Andhra Pradesh is the one stop solution for medical devices manufacturers and innovators, which will categorically reduce the cost of manufacturing and pave way to make healthcare more affordable and accessible How does Andhra Pradesh (AP) government look at the medical devices sector? What kind of measures have been taken so far to boost the sector?

The Indian medical devices market has grown from $ 2.02 billion (` 13,130 crores) in 2009 to $3.9 billion (` 25,259 crores) in 2015 at a CAGR of 15.8 per cent. This accounts for approximately 1.7 per cent of the global medical device market in 2015. The industry estimate suggests that the Indian medical devices market will grow to $8.16 billion (` 53,053 crore) in 2020 at a CAGR of 16 per cent. India is one of the top 20 global medical devices markets and the fourth largest in Asia. However, the current Indian market is import dependent to the extent of 78 per cent with that on complex technologies – over 90 per cent.

Fortunately, Indian medical devices industry is also a sunrise sector in the healthcare space, and AP government understands its potential in creating affordable and quality healthcare for all. So the state government has taken a holistic approach to identify the hurdles and possible solutions to overcome them in medical devices sector.

Andhra Med Tech Zone (AMTZ) – ‘One Stop Solution for Medical Devices Manufacturers and Innovators’ is AP government’s strategy to boost the medical devices sector. The creation of AMTZ is based on the fact that

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medical devices manufacturing requires certain high investment facilities which are too capital intensive for individual manufactures to invest upon.

A park with in-house high investment scientific facilities would help manufacturers reduce the cost of manufacturing.

six months of establishment, 20 per cent of the zone is already booked. The pace has been excellent and the confidence of domestic manufacturing sector has been assuring.

Do you think that establishment of the AMTZ and increased FDI investments amongst private hospitals within the state can boost medical device exports from AP? (if yes, share few figures) We expect 250-300 manufacturers to set up their units in AMTZ. We assume each to touch a modest turnover of `50 crores, and 25 per cent of it to be through export market that would lead to an export potential of `3750 crores, approximately 15 per cent of India’s current import dependency.

Visakhapatnam has got the priority status for fiscal policy. How can medical devices manufacturers leverage this opportunity?

Visakhapatnam district has been accorded a priority status on September 30, 2016.

This brings with itself 15 per cent investment allowance and 15 per cent additional accelerated, culminating in substantial potential for manufacturing sector.

Tell us more about the AMTZ. The zone is proposed to have all high investment scientific facilities in-house to reduce manufacturing process costs.

It will have modern state-ofart 250-300 independent manufacturing units, each over a built-in ready to use area in 1.00 acres/0.50 acres /0.25 acres, at a very cost-effective long-term lease rate for 33 years. Located in an area which is well connected with rail, road, waterways and airport and proximity to industrial corridors, port and harbour to reduce logistical costs. AMTZ in Visakhapatnam is India’s first medical devices manufacturing zone spread over 270 acres. Within

India’s first medical device manufacturing zone is expected to reduce import dependency and the cost, without compromising on the quality.

Thus, it will help in making healthcare more affordable and accessible

How does the AMTZ differ from other medical devices hubs ?

AMTZ is an integrated medical devices manufacturing park, and its uniqueness is the innovative ecosystem that it offers, which encompasses every possible aspect to make a business success.

This includes ◗ Prebuilt manufacturing units ◗ Capital intensive common ◗ Scientific facilities on pay per use model ◗ Lower cost for testing services ◗ Finance and technology transfer services ◗ Central warehouse and

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logistics ◗ Promotional activities ◗ Med tech Expo Halls, convention centre, etc. ◗ Regulators and export facilitation How will AMTZ project add value to the healthcare sector within the state?

The indigenous products coming out of AMTZ park is expected to reduce import dependency and the cost, without compromising on the quality. Thus, it will help in making healthcare more affordable and accessible. It is expected to generate huge employment, and will ensure the skill building exercise turns the region into a hub for medical device engineering.

As the SEZ has not been a good option in our country, do you think AMTZ would be benefit in the long run?

AMTZ is not a SEZ, as its primary focus is to reduce import dependency and then to become a global leader. The option of SEZ forces a manufacturer to primarily produce for export market. In case of medical devices, this would deny the manufacturers of the domestic market which has a huge potential. Hence, strategically the zone has been kept as a non-SEZ area.

witness India’s medical devices growth story, leveraging parks like AMTZ. As mentioned it is one stop solution, in next five years is expected to be the hub of innovation, which will craft the story of indigenous medical devices to

make the dream come true – ‘Affordable quality healthcare for all’. Recent launch of national diagnostics programme including tele-radiology and CT scan facility in public hospitals, national dialysis programme, and a

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volvement of public health institutions in core clinical activities and undertaking strategic purchasing of noncore clinical functions such as equipment maintenance. prathiba.raju@expressindia.com

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What is the investment expected in the current fiscal?

Investment will vary as the medical devices industry is myriad with each category having their unique need. The investment will be in the form of plant, machinery, knowledge, patents and of course the manufacturing plant inputs in terms of raw materials, which would be a boost to the local supply chain and component industry.

In the next five years, how will the state contribute in boosting the medical devices industry in the country?

AMTZ being the vanguard is expected to inspire many states to come up with similar models/parks. So, in the next five years, we are bound to

plethora of such pro-public initiatives, are creating the right balance of access, supply and partnerships required for a bubbling healthcare eco-system. We are striving now to achieve a right balance between in-

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INSIGHT

Dental health sector in India – ASWOTanalysis

DR AARTI SHARMA KAPILA Head- Quality Clove Dental

Dr Aarti Sharma Kapila, Head- Quality, Clove Dental, gives a rundown on the dental care in India and elaborates on the opportunities and challenges for growth in this sector ORAL HEALTH care is an integral part of overall health, however this remains the most neglected part in our country because most of the people visit a dentist only when it is unavoidable. With a very high prevalence of dental disease (approximately 87 per cent), amongst the Indians population the oral healthcare sector is geared for a giant leap provided we generate awareness about dental disease and its consequences as well as about quality dental treatment facilities available in semi-urban and rural areas. Unlike countries abroad, dental treatment is not covered by any of the insurance companies in India. Hence, every dental treatment has to be paid by the individual which in itself is quite dampening as people generally believe that unless a ‘tooth is hurting’ why should they visit a dentist and ‘hurt their pockets.’

India’s healthcare sector is a combination of state-of-the-art healthcare providers to unregistered doctors and unqualified quacks. The situation is the same in dental healthcare too. In order to bridge this gap between healthcare providers and patients, there is a need for a massive increase in dental institutes and their productive capacity. In total there are 310 dental colleges in the country, of which only 40 are government, producing 30570 dentists annually.

However, the problem arises when these dentists are not available to the masses at large and remain concentrated in certain regions, predominantly urban. This situation gives rise to problems such as poor quality of dental treatment, ambiguity in

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Picture used for representational purpose only dentists qualifications, increased demand in terms of economy and sustainability.

Let's examine the various aspects which characterise dental care in India with a SWOT analysis

Strengths In Prime-minister Modi’s words, India’s population is its strength. Dental community should be able to use this staggering number to its advantage.

The country has exceptional avenues for advanced learning and dental professionals can

keep themselves abreast with the latest advancements to give their patients the best dental care possible. Further, dental treatment in India is affordable and there is a sharp rise in dental tourism, putting India and its dentists on the world map.

The introduction of quality assurance certificates such as ISO, NABH by the Quality Control of India and formation of many dental corporates are helping in increasing the avenues for dentistry.

Weakness

The surprising question that looms large is, “Why does India still lag in channelising dental professionals?'' According to WHO Health Statistics in 2004, dentist-population ratio in India was 1:30000, and in 2014, the ratio was 1:10000. In the year 2004, India had one dentist per 10000 people in urban areas and one dentist per 1.5 lakh people in the rural areas. This demand and supply disparity causes excessive burden on the dental professionals practicing in the rural areas, forcing them to sharply decrease the quality of

dental treatment. Quality comes with a cost and when the treatment versus cost is not met, the axe falls on quality first.

In 2014, NHS England, tried to trace patients for blood borne disease and HIV treated by a dentist over a period of 32 years and had not followed proper sterilisation protocols. It was found that he was keeping dental equipment in the staff toilet.

In India, we yet do not have a body to keep a strict check on the quality of dental professionals and their work ethics. The guidelines are revised from time to time but there is no audit team to check.

Government job vacancies for dental professionals are very less in number. Records show that only five per cent of graduated dentists are working in the government sector. The government also often lags in providing basic amenities to doctors working in rural areas.

Most set ups are not fully developed or do not have a specialist and hence the patients have to run to urban areas.

Another major challenge is the number of post-graduate students or the seats available in dental colleges. The total number of post-graduate seats available are only around 3000 compared to each year pass outs of nearly 25000 dental graduates.

This imbalance between graduates and postgraduates causes concentration of dental surgeons in the urban areas.

Opportunities With multi-dental institutes and many private sector corporate chains emphasising on work ethics, many dental healthcare

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IN TOTAL THERE ARE

310 40

DENTAL COLLEGES IN THE COUNTRY, OF WHICH ONLY

ARE GOVERNMENT, PRODUCING

30570 DENTISTS ANNUALLY

workers have a better opportunity. However, much needs to be done in this area. Evidence-based workforce plans, especially in the poorest and most fragile states, to motivate existing interns to work in the rural areas and prevent the mushrooming of dental set-ups in one particular area or city is the need of the hour. Such practices have the opportunity to provide a platform for young dental graduates and post graduates to be gainfully employed.

Threats With the opening up of many private set ups, the threat of sustainability for each individual practice increases. However this does not affect a multi-practice chain as much. Also, the examination system and the process of dental selection in the country needs a few amendments. But with the government’s initiative of National Eligibility and Entrance Test (NEET), barriers in terms of quality will be met. The challenge will be for those who will not be able to meet the NEET criteria. However, the government will still not be able to prevent these fresh graduates from bee-lining towards the urban areas, until and unless they make working in semi urban and rural regions lucrative.

The Clove model In order to provide quality den-

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tal treatment, many corporate dental chains have opened up in the country and are expanding rapidly so that every citizen rightfully gets dental treatment without any compromises. One such dental organization is Clove Dental which firmly stands and works on its three pillars namely

Quality, Integrity and Ethics.

Chains like these work on strict disciplines of ethics and selects dentists from across the best institutes of the country.

Each doctor further undergoes retraining. Each Clove Centre follows a very strict four-step sterilisation protocol which is

also checked upon by a quality team of the organization and has a unique program of real time assessment of all dental treatments being done by its clinicians to prevent malpractice.

With its collaborators from across the globe, Clove Dental provides latest dental treatment

techniques. This has solved the problem of unemployment amongst dental professionals as similar chains offer the opportunity to be practice owners without any financial stake and the worries of administration issues that arise from running such a practice.

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POST EVENT

TMC hosts three-day conference to celebrate platinum jubilee year Experts convene from across the globe to share their learnings and debate on ways and means to create an ideal health system TATA MEMORIAL Centre, as part of its platinum jubilee celebrations, recently hosted a three-day conference in collaboration with the Ministry of Health & Family Welfare, Tata Trusts and Harvard TH Chan School of Public Health, at the Tata Institute of Fundamental Research in Colaba, Mumbai. The conference revolves around a very pertinent and perennial question, Is healthcare a commodity or a basic need?

National and international experts have convened at the conference to discuss and deliberate on the various aspects of this issue and exchange notes on operating sustainable healthcare systems. The first day of the conference began with an inaugural address by Dr RA Badwe, Director, TMC who welcomed the delegates and gave an overview of what’s in store over the next three days of the conference.

After his address, international experts from across the globe took the stage to showcase the healthcare systems in their respective countries and the various measures implemented to ensure quality healthcare to the citizens.

The speakers who took the stage were Bernard Couttolenc, Chief Executive Officer of the Performa Institute, São Paulo, Brazil, Somsak Chunharas [Senior Public Health Advisor and former Deputy Prime Minister for Public Health, Thailand; Kennedy Lishimpi, Director, Cancer Diseases Hospital, Zambia;

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Ryozo Matsuda, Professor in Health Policy and Community Health, College of Social Sciences, Ritsumeikan University, Kyoto; Maziar Moradi-Lakeh Institute for Health Metrics and Evaluation (USA) & Iran University of Medical Sciences (Iran); Karine Chevreul, Professor, Public Health, Health Economics and Health Services Research Unit, University of Paris and Osvaldo García González [Professor, Cuba’s Sports Medicine Institute.

A panel discussion with these experts followed wherein the experts addressed topics like the ways and means to achieve UHC , models of healthcare financing, maintaining efficacy and quality in public health systems and tackling the disparities in healthcare

delivery etc.

The second session saw representatives from healthcare institutions in India share the stage to present their healthcare model and its advantages. Dr Sanjay Oak, Former Director Medical Education & Major Hospitals, MCGM, who presented the public health model in India, highlighted the challenges in this model and called for more accountability, change in the current approaches as well as out-ofthe-box strategies to deal with the chinks in the system.

Dr BS Ajaikumar, Chairman, HCG, showcased the private healthcare system in the country and highlighted that his model revolves around offering comprehensive cancer care with the highest quality. He also

opined that affordability should be measured in terms of outcomes.

Dr Badwe spoke of the TMC model which provides affordable cancer care and uses a combination of hub and spoke model, education and research to enhance cancer care in the country. Dr Sunil Chandy presented the CMC Vellore model of healthcare which is firmly rooted in the principle f service. He was very vocal against commercialisation of healthcare and said that healthcare should be ensured to every person who needs it, irrespective of which social strata he/she belongs to. Dr P Namperumalsamy, Chairman- Emeritus, Aravind Eye Care System, highlighted that service and business can be combined to create a successful health-

care system and showcased Aravind Eyecare System as an evidence of this point. A panel discussion with all these experts as well as Dr JP Gupta, Commissioner – Health, Gujarat and Dr Avinash Supe, Dean & Director, KEM was also held wherein the panelists discussed on the sustainability and efficacy of each model, their replicability, learnings which can be implemented to create a better public health system, areas to collaborate etc. Dr Benjamin Anderson, Chair & Director, The Breast Health Global Initiative, Fred Hutchinson Cancer Research Centre was the moderator for this session.

The panel discussion was titled, ‘Scalability, Growth and Affordability of Institution Models’. The other panel discussions for the day were on ‘Efficacy Endpoints in Healthcare Delivery’, and ‘Access to Affordable Care’. Experts drew attention to the need for proper guidelines to ensure best quality healthcare, a yardstick to measure the efficacy of the current health systems, making UHC a direction than a destination and similar pivotal points.

Health economists, policy planners, administrators, clinicians, patient advocates, epidemiologists, regulators and other stakeholders were part of the conference. TMC plans to collate the learnings over the three-day conference and create a ‘Mumbai Declaration’ which will be presented to the government.

MARKET

NEWS

Columbia Asia Hospitals ties up with PDMD, Cameroon In March 2017, PDMD - Cameroon will start a polyclinic with world class diagnostic facilities in Douala, capital of Cameroon's Littoral Region COLUMBIA ASIA Hospitals group has recently tied up with PDMD, Cameroon for provision of tele-radiology, tele-consult and tele-education services. As part of the E-health initiative, the telemedicine programme at Columbia Asia Hospitals, extends expertise of its renowned physician from India to meet the needs of patients across the globe. In March 2017, PDMD - Cameroon will start a polyclinic with world class diagnostic facilities in Douala, capital of Cameroon's Littoral Region. The centre will be equipped with MRI, CT scan, mammography, X-Ray, USG and laboratory facilities.

“This partnership with Columbia Asia will help me provide international quality services to my patients as well as help my country Cameroon in particular and the countries of the sub region such as Chad, Central Africa Republic, Gabon, Congo Brazzaville and even Guinea Conakry in general,” said Paul Guimezap, CEO, PDMD & President, IUCL’Institut Universitaire de la Côte,Cameroon.

“Through PDMD, we will deliver internationally benchmarked medical practices to the people of Cameroon and surrounding region. In addition to tele–radiology and consultation, we will also help build capabilities in the country by collaborating to provide radiology skill development through the educational institute run by PDMD,” said Dr Harsha Rajaram, VP – Telemedicine, Columbia Asia Hospitals.

The Columbia Asia Hospitals - India has been providing tele-radiology services for remote areas in India and also across seven countries including Indonesia, France, Saudi, Bahrain, Kenya and Uganda.

EH News Bureau

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‘Male engagement in family planning could act as a catalyst in improving contraceptive uptake’ Poonam Muttreja, Executive Director, Population Foundation of India, in a conversation with Viveka Roychowdhury, elucidates about the need to focus on dispelling myths and misconceptions. She also talks about many benefits in terms of health and nutrition outcomes which will result in a better uptake of contraceptives and an increased shared responsibility within the family What have been the major developments in family planning and reproductive health in India in the past year?

The year 2016 has been a significant one in terms of developments for family planning in India. To my mind, the most notable of these has been the Supreme Court verdict on the Devika Biswas Vs Union of India case, which has greatly encouraged many of us, who work in this field. What makes the judgment exceptional is the fact that it lays out the groundwork for organisations and people who anchor their work in a human rights framework, to come together – and work in concert to make sure that the guidelines that have been laid down are implemented and adhered to.

Additionally, the judgment has three critical directives that make it a defining moment in family planning legislation. It calls for: the phasing out of sterilisation camps in the next three years; asks states and Union Territories to desist from setting targets, which could be misused to coerce people into undergoing sterilisation; and lastly, directs them to make family planning programmes better in terms of access to doctors that are empanelled, availability of information in the vernacular, and making certain that the client has been fully informed about the pros and cons of the procedure before deciding to go for it – all these combine to tackle the challenges hitherto prevalent in this regard.

On the need to increase the method mix of contraceptives on India, we witnessed the forward-looking steps taken by the Ministry of Health and Family Welfare (MoH&FW) in the family planning programme, including the introduction of three new modern spacing methods, which included: injectable contraceptives, progestinonly pills and centchroman in 2015.

These have all been supported by an implementation plan and a series of trainings to ensure smooth and effective delivery.

India is still a fairly patriarchal society, what have been the approaches which have succeeded in family planning and reproductive health rights?

The existence of patriarchy has led to an all-round infringement of women’s rights and in the process also impacts deterioration of women’s health in the country, adding to the already existing adverse health outcomes for women in general - early marriage, early age of pregnancy, desire for a son which leads to several abortions and pregnancies, lack of education and choice. There is a need for policies that are more’ comprehensive, which keep girls and women at the centre of the policy framework with an approach that focuses on empowerment as opposed to welfare – and which is not dictated by just an elevation of indicators. There is a need to translate the language of rights into action plans.

We need sustained engagement of men in reproductive health and family planning practices and services - not just as clients, but as responsible partners. This has the potential to dramatically improve the use of family planning services and bridge the gap of current unmet need for contraception, which according to NFHS III stands at 12.8 per cent. Evidences suggest that male engagement in family planning could act as a catalyst in improving contraceptive uptake in an already aware and willing population (according to NFHS-III) apart from system issues such as accessibility or availability etc.

Given that the contraceptive use by men in India is riddled with social barriers and challenges, a systematic

We need sustained engagement of men in reproductive health and family planning practices and services - not just as clients, but as responsible partners

integrated approach with IEC activities for women and men are required. There needs to be a targeted focus on dispelling myths and misconceptions and on presenting the many benefits in terms of health and nutrition outcomes for the family with messages which will work. This would result in a better uptake of contraceptives and an increased shared responsibility within the family. Towards this end, we need sustained behaviour change communication and on-ground work to engage men while promoting women’s rights and decision making. This is absolutely vital.

Population Foundation of India (PFI) has been working to bring about behaviour change through its edutainment TV series called Main Kuch Bhi Kar Sakti Hoon - I, A Woman, Can Achieve Anything (MKBKSH), targeted at men, women, couples, adolescent girls and boys. We believe that the overwhelmingly adolescent population in India is a demographic advantage that we need to capitalise on.

Targeting them to bring about the necessary mindset and behaviour change will impact the overall healthcare status of India in the longrun. The series episodically touches upon various aspects of family planning and reproductive health and the myriad prevailing social taboos. It has been well received with the audiences and has shown us that by weaving appropriate messages into a compelling story that entertains, educates and resonates, edutainment increases knowledge, promotes positive attitudes and changes behaviour.

What percentage of the health budget gets spent on family welfare?

An adequate budget is the key to sustaining a number of important initiatives under the country’s Family Plan-

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cover ) ning Programme. The allocation for health in 2016’s budget has been increased by 22 per cent over the previous year’s budget estimated at ` 39,533 crores. However, despite the increase on paper, the relative importance to health in the budget is inconsequential.

The share of family welfare increased marginally from four to five per cent of the health budget in 2016. The Health & Family Welfare Budget estimate for the current financial year is around 3.7 per cent of the total central government budget, which is almost the same as that of the FY 2015-16.

As per the Economic Survey of 201516, Government of India’s public spending on healthcare is only 1.3 per cent of GDP, which is about 4.9 per cent of the total Government expenditure.

This is substantially lower than many developing countries such as Sri Lanka and Cuba which spend 2.0 per cent and 5.5 per cent respectively. Even though allocations for health have risen threefold from 2005-06 to 2014-15, spending on health and family welfare as a percentage of the overall expenditure accounted for less than two per cent.

Much higher allocations are necessary to successfully carry forward the family planning agenda with a sharpened focus on reproductive health and rights, quality of care and spacing methods.

Given that 70 per cent of India’s population is in the reproductive age group, how much does India spend on contraception, family planning as part of the health budget? Is this sufficient?

India’s population has a huge youth bulge which is in the reproductive age group.

Currently, as the 2011 Census shows, the country has over 225 million adolescents (10-19 years), which is around 21 per cent of the population and over 189 million youth (15-24 years), which is 19 per cent of the population. Together they form 311 per cent of India’s population. Given India’s young population, it is important that comparative attention is paid to spacing methods with a budget that is adequate - this needs to be much higher than the current 1.45 per cent of the total family planning expenditure. Based on the MoH&FW approval to the introduction of new methods and emphasis on spacing methods in the family planning programme, there is a need to increase investments in family planning.

These are essential requirements to address the unmet need in family planning and for India’s economic and social sustainability.

Investments in family planning

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According to the UNCESCR, four interrelated and essential elements of the right to the highest attainable standard of physical and mental health are: availability, availability, accessibility, acceptability and quality contribute significantly to improving the health of women and children. An analysis of India’s recent family planning budgets reveals that the Family Welfare Budget of the Central Government (Department of Health and Family Welfare) actually reduced by 87 per cent, from ` 12,278.65 crores in 2013-14 to ` 1605.37 crores in 2014-15.

Consequently, the share of family welfare in the total health budget of the Central Government reduced from 34 per cent in 2013-14 to 4 per cent in 201415. Family planning expenditures constituted just 6 per cent of the Reproductive Child Health (RCH) expenditure and hence two per cent of the National Health Mission (NHM) expenditure in 2013-14.

A PFI study shows that India needs `187.3 billion in the coming four years (almost ` 47 billion per year) if it has to cover 48 million new users of contraceptives by 2020 (all by the public health system), a commitment made by India at the London Summit on Family Planning in 2012. This is ` 113.8 billion more than what is projected by the government budget allocation. It is time that the government allocates the much-needed resources and gives family planning a boost. Family planning is a key investment. Let us use it to our advantage.

Several states in India have skewed sex ratios, reflecting high female foeticide rates. How has PFI addressed this issue?

The decline in the child sex ratio - CSR (0-6 years), as reported by the Census of India, from 945 in 1991 to 927 in 2001

and further to 919 females per 1,000 males in 2011 is cause for alarm and urgency. India’s 2011 Census revealed a growing imbalance between the numbers of girls and boys aged 0-6 years, indicating that India is still hesitant to daughters being born.

Out of 640 districts in the country, 429 districts have shown a decline in the child sex ratio. Haryana recorded the worst CSR of 834 while Arunachal Pradesh had the highest CSR of 972. 13 out of 35 states and UTs have CSR lower than the national average of 919.

A declining sex ratio is only the conclusion of a long drawn out matrix of social and cultural interactions.

Patriarchal cultural and social norms continue to influence mind-sets and attitudes and promote gender inequalities on a daily basis in peoples’ lives. In addition to the awareness campaigns and advocacy with the stakeholders, including elected representatives, corporates, civil society and media at the state and district level in more than 10 states, PFI embarked upon a multi-media edutainment initiative called Main Kuch Bhi Kar Sakti Hoon which translates to ‘I, A Woman, Can Achieve Anything’.

Central to the initiative is a soap opera series which aims to increase girls and women’s agency by promoting gender equality, women’s empowerment and access to healthcare. The media initiative has worked to enhance knowledge of social issues such as child marriage, family planning and pre-natal sex selection and challenge discriminatory social norms affecting women and girls.

It has been very encouraging to note that the findings of the endline evaluation which sought to assess changes in the Knowledge, Attitude and Practices (KAP) on family planning, child marriages, son preference, gender discrimination, domestic violence and sex selection, have shown positive changes. They distinctly show that programme has had a measurable and positive impact on the knowledge and perception of the viewers and women’s agency.

A major lacuna in family planning was that there was little choice in contraceptive methods, especially those that put the decision in the woman's hand. Has the situation improved? Are there contraceptive measures which empower the woman to make the choice hers alone?

Giving women autonomy over their bodies and the power of making decisions related to their sexual and repro-

ductive health is one of the most significant ways to empower women. Family planning plays a major role in this and access to contraception and choice is one of the most effective ways of doing so. Efforts need to be undertaken to make women aware that they have the right to decide when and how many children they wish to have as well as the fact that they have the right to access family planning services and counselling. However, it is equally important to ensure that quality family planning services and choice in the method mix is available. These steps will enable her to take informed decisions and choices.

According to the UN Committee on Economic, Social, and Cultural Rights (UNCESCR), four interrelated and essential elements of the right to the highest attainable standard of physical and mental health are: availability, accessibility, acceptability and quality.

However, the availability and accessibility of contraceptive services has been a concern for women in India.

As per the National Family Health Survey (NFHS III) data the desired family size in India is less than two children and almost 32 million women’s family planning needs are not met. This indicates that despite the fact that women want to delay or stop childbearing, they are not able to access or use contraceptive methods. The lack of information, insufficient access and limited choice of spacing methods have resulted in India relying heavily on female sterilisation.

Expanding the basket of choices of contraceptive methods is the only way to ensure that family planning doesn’t turn into a forced operation due to a lack of choices and access. Over the past year, things have appreciably improved with the MoH&FW introducing three new methods – Progesterone-only-Pills (POPs), centchroman and injectable contraceptives, to the basket of contraceptive choices. These have not only increased methods which are easily accessible to women but have also made available options which focus on spacing.

This stride made by the Ministry will certainly go a long way in empowering women with the choice and the right to make an informed decision about their sexual and reproductive health.

In 2015, India accounted for an estimated 15 per cent (45,000) of all maternal deaths (303,000) worldwide. India lags other developing nations when it comes to meeting the Sustainable

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Development Goals (SDGs) related to health, especially where women's and child health is concerned. What are your recommendations to policy makers to plug the gaps in the current policies and schemes?

India has taken some commendable steps to progress towards ensuring safe motherhood for women in recent years. However, any satisfaction one may derive from the decline in the maternal mortality ratio is tempered by the fact that the country still accounts for a significant percentage of all global maternal deaths.

Rights and empowerment principles are central to strategies for realising the SDG’s and Family Planning 2020 vision and goals. Indeed, much more needs to be done to meet them. There is a need to ensure that human rights are treated as the foundation for the sexual and reproductive health programme in the country.

To begin with, the right to sexual, reproductive and population education is lacking – which itself is a violation of the right to informed decisionmaking. To exercise full, free and informed decision-making, access to accurate, clear and readily understood information and the full range of safe and effective services that are obtainable should be made available.

Both the choice of methods in family planning and the lack of counseling have on many an occasion led to coercive practices infringing the rights of women and girls. There have been instances where the protocol of quality of care has not been followed, thereby putting women’s lives at risk.

To address these concerns, there is a need for better onground implementation of programmes, instituting strict monitoring for quality of care and the formation of a redressal mechanism – to address SRHR grievances for women and men to reach to their full potential.

One aspect of maternal health, often overlooked in India, is unwanted or early age

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pregnancies and the high unmet need for contraception.

According to the NFHS III, adolescents (15-19 years) contribute about 16 per cent of the total fertility in the country and the 15-25 years age group contributes to 45 per cent of

the total maternal mortality.

Nearly 21 per cent of all pregnancies are either unwanted or mistimed. This not only exposes women to avoidable maternal health complications, it also affects their overall development and

well-being. A more accessible and equitable family planning programme that offers a wider choice of contraceptive methods to couples constitutes a simple, low-cost investment which can reduce maternal and child mortality by

preventing early age pregnancies and unwanted pregnancies at a later age. The addition of a new method made available to at least half the population correlates with an increase of four to eight percentage points in total

cover ) contraceptive use.

However, it is important to note that the issue of safe motherhood in India is much wider in scope than providing healthcare and family planning services for women. It involves a wider debate about their education, dignity, and reproductive rights and denying them the choices, they should be making on their own.

What is your vision for the coming year in terms of family planning and reproductive health, and women health issues?

We have started an exciting journey this year with the Supreme Court judgement. We need to be vigilant and monitor the on-ground implementation of the SC directives. The government needs support and we must review adherence to quality guidelines in implementing the injectable roll-out. Alongside, we should look at the successful models in other nations ahead of us on various health indicators and consider adopting good practices and striving constantly to expand the basket of contraceptive choices for women and young people.

PFI will continue to work with the government and other civil society organisations to collate evidences and further expand the basket of contraceptive choices based on scientific evidence and global best practices. In the coming year, we are looking to creatively use the behaviour change communication tools and the media to change the social determinants that inhibit contraceptive use and male participation in family planning.

We look towards greater convergence between the efforts of the government, civil society organisations, parliamentarians and the private sector to collectively take strides towards realising India’s commitments to the FP2020 goals and the SDGs. What is the role of civil society in India’s policy related to reproductive, maternal, newborn, child, and adolescent health (RMNCH+A)? Is civil society as proactive as required?

PFI does not believe in population control and has worked hard to shift the discourse from control to population stabilisation. In fact, post the ICPD Conference in Cairo in 1994, there has been a paradigm shift in India as well as at the international level with population stabilisation gaining increasing currency. The emphasis on family planning in a population stabilisation

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The emphasis on family planning in a population stabilisation framework has further amplified after the 2012 London Summit on Family Planning framework has further amplified after the 2012 London Summit on Family Planning.

Often population stabilisation continues to be viewed as population control. However, these are two very different concepts. Organisations such as ours, strive towards advancing reproductive rights and choice for women and men. To achieve this, multiple stakeholders, including NGOs and corporates need to work along with the Government. NGOs can play a significant role by: i) increasing public and political participation in family planning and contraception; ii) creating awareness on the need for family planning; iii) advocating for an increased basket of choice and increased budget; and iv) by ensuring a rights-based approach in family planning policy and programmes in the country.

Which are the states which have fare better in terms of family planning and reproductive health? What are the indicators PFI tracks and your comments on successful interventions?

Total Fertility Rate (TFR): TFR indicates the average number of children expected to be born per woman during her entire span of reproductive period. This is assuming that the age specific fertility rates, to which she is exposed, continue to be the same and there is no mortality .

The TFR for India in the year 2013 was 2.3 per woman and varies from 2.5 in rural areas to 1.8 in urban areas. Among the major States, the TFR level of 2.1 has been attained by Andhra Pradesh (1.8), Karnataka (1.9), Kerala (1.8), Maharashtra (1.8), Punjab (1.7), Tamil Nadu (1.7) and West Bengal (1.6). Thus, the southern states are faring well in the total fertility rate, which is one of the important family planning indicators.

Among the bigger states, it varies

from 1.6 in West Bengal to 3.4 in Bihar.

For rural areas, it varies from 1.7 in Himachal Pradesh, Punjab and Tamil Nadu to 3.5 in Bihar. For urban areas, such variation is from 1.2 in Himachal Pradesh and West Bengal to 2.5 in Bihar and Uttar Pradesh.

The TFR has a direct and an indirect correlation with various factors such as whether it is a rural or an urban area, education, economic status etc.

Education, more precisely female education, has a direct impact on fertility. To ascertain the levels of fertility by the educational status of women, three indicators viz. general fertility rate, age-specific fertility rate and total fertility rate have been mentioned for rural and urban areas.

The total fertility rate for women having the educational status 'Illiterate' for 2013 is 3.1. This is much higher than the 'Literate' group of women. Among the 'Literate' (2.1), there is a gradual decline of TFR with the increase in the level of education. At the national level, for the same year, the total fertility rate going by the women’s level of education, has been calculated separately for the rural and urban areas.

Education level The percentage of female population in the age group 15-49 by level of education, at the national level and for the bigger states is described in the table below. At the national level, 29.0 per cent of the female population is reported as 'Illiterate' against 71.0 per cent in the 'Literate' category. Of the literate women, about 81.1 per cent have an education up to Class X, 11.1 per cent an education level of Class XII, with only 7.6 per cent having reported levels of graduate or above. Among the illiterates, Kerala 1.1 has the lowest and Bihar 47.7 the highest percentage of illiterate women. Since the TFR has an established relationship with education, it can clearly be seen that the southern states, which have a higher level of education among women have the lowest levels of TFR. Age at Effective Marriage (AEM) The Mean Age at Effective Marriage is the age at consummation of marriage.

This is almost stagnant and hovered around 20 years between 2005 and 2009. The State level data show variations in the AEM. It is the highest in J&K (23.6) followed by Kerala (22.7), Delhi & Tamil Nadu (22.4), Himachal Pradesh (22.2), and Punjab (22.1) in 2009. Rajasthan (19.8) has the lowest AEM. The AEM in urban areas is

higher than the rural one but the difference is just two years. The ruralurban difference is highest (3.1 years) in Assam and the least in Kerala (0.1 years). For more than 50 per cent females in rural areas, the AEM is 18-20 years whereas in urban areas, the AEM is 21+ for more than 60 per cent females.

Medical attention at delivery While recording the details of every outcome of pregnancy during continuous enumeration and half-yearly surveys, the enumerators and supervisors are required to enquire about the type of medical attention received by the mother at the time of delivery of the newborn or at the time of abortion. In the new sample from 2004, the options on the types of medical attention received by the mother at delivery have been modified to capture the deliveries specifically at private hospitals/nursing homes. The new options include: government hospital; private hospital; qualified professional; untrained functionary and others in comparison to institutional; doctor, nurse or trained midwife; traditional birth attendants; and relatives or others adopted in the 1991 SRS sample.

Statement 40 below gives the percentage distribution of live births separately by rural and urban areas recorded in the year 2013 for India and bigger states by type of medical attention received by the mother at the time of delivery. At the national level, 50 per cent births were attended to at government hospitals and vary from 48.8 per cent in rural to 55 per cent in urban areas. Among the bigger states, it varies from 33.1 per cent in Jharkhand to 67.9 per cent in Rajasthan. About 24.4 per cent of births occurred at private hospitals. Medical attention by qualified professionals constitutes 12.7 per cent of the total delivery whereas untrained and others constitute 12.9 per cent. More than three-fourth of deliveries are occurring in institutions and being conducted by qualified professionals.

Though, we at PFI track all the health indicators, we pay specific attention to those pertaining to reproductive and sexual health, as they are of special interest. PFI also closely tracks and analyses the health and family planning budget since synchronisation between the budget and health indicators is a must for the sustainability of any programme. viveka.r@expressindia.com

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‘Policy formulation by the government is working towards the right direction’ Lokesh Sharma, Head, Public Health – Africa, Middle East, South Asia, QuintilesIMS, speaks on the steps needed to reform public health in India and shares the learnings from some of the projects implemented by his organisation in this sphere, in an interview with Viveka Roychowdhury As Head of Government Solutions in India for QuintilesIMS and Director, QuintilesIMS Institute India, describe some of the public health projects that the Institute manages for the public health segment in India.

We have worked across the spectrum in the public health domain from providing policy support to improving the service delivery, infrastructure and skill development, and capacity building in the public health space. We have been closely working with NITI Aayog on the accessibility issue and have given recommendations on enhancing the role of private sector in setting up medical colleges, upgrading the infrastructure for managing non-communicable diseases.

We are also working on the ways of engaging the private sector for improving the service delivery and patient adherence in TB supported by the Bill & Melinda Gates Foundation in multiple states of India. On infrastructure development, we have worked with the Government of Nagaland and working with development agencies like World Bank. We are also undertaking supply chain assessment and programme monitoring and evaluation with agencies like UNDP and WHO as well as working closely with organisations like DGHS and Pharmexcil.

You have worked with various state governments in India.

What are the solutions to bridge the gap between the

developed and developing states, in terms of health indicators and health outcomes?

In the e-vaccination initiative of the Government of India, which is supported by UNDP, we supported the preparatory assessment of supply chain of vaccines across 12 states. We assessed their readiness for deployment of technology solutions to manage the logistics and supply chain of the vaccines. As this is being implemented, the situation of availability and distribution of vaccines at the public health will improve drastically. We worked with the Government of Karnataka on a pilot programme for providing prevention and management services for non-communicable diseases at the primary facility level. There were some key learnings which can be incorporated in the National Programme for Prevention and Control of Diabetes, Cardiovascular Disease and Stroke (NPCDCS) to make it more effective.

On the policy formulation and advocacy front, what are the most viable models for India, with proven success which balance patient access with affordability?

It is important for the government to focus on disease burden assessment, robust delivery framework, and resource planning for policy formulation, to ensure there are enough resources including manpower, infrastructure and finance to bring in efficiency into implementation of the policy on ground. Also, the

major role in improving implementation.

In Tamil Nadu, which has successfully set up medicine procurement management system, effective implementation has made all the difference and not the policy. While many states have visited Tami Nadu models, none of the states have been able to replicate it yet.

Similarly, the medicine procurement management systems developed for Rajasthan by C-DAC’s e-Aushadhi has been appreciated for its ability, not only in procurement but also monitoring prescription practices, including antibiotics and rational use of medicine.

The government along with the industry needs to aggressively focus on the operational and the implementation aspect of the policies transition of the policy making should be from responsive to being proactive. There are many examples to prove that proper resource planning and effective allocation can play a

Reference The Lancet report on how countries fare on the GBD data, India lags on the health-related SDGs. What are the policy decisions that government, industry leaders need to take to make sizeable gains and avert a public health crisis in India?

India witnessed unprecedented progress in terms of economic development, mortality and diseases profile.

Policy formulation by the government is working towards the right direction. However, the government along with the industry needs to aggressively focus on the operational and the implementation aspect of the policies. We need to be more realistic and look at capacity building of the resources at hand during policy formulation to make the desired progress. To achieve sizeable gains it is important

for the government and industry to develop partnerships with a focus on improving the coverage and providing accessibility to quality healthcare services to the people.

You have led large Technical Assistance Programmes funded by the donor agencies such as DFID, ADB, IFC and the World Bank in many states. What have been the challenges and how were they overcome?

While working with the donor agencies, it is important to ensure that both sides complement each other’s effort in terms of dedicating similar kind of resources, efficacy of work, and scaling up the initiatives to a larger framework and continuous monitoring and evaluation. These would be the key considerations from any support which is being given by the funding agencies.

Typically, every programme taken up is supported by donor agencies through the initial or pilot phase. Later, the programme is driven by the state or central governments.

Some of the programmes that we have driven have really worked well and have been adopted by the government scaling it up further. However, there have been few programmes, wherein the government was unable to drive it further due to lack of resources. Therefore, it is pertinent to have a knowledge management and capacity building module in all the technical assistance programmes. viveka.r@expressindia.com

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Every senior medical doctor should earmark one month in a year to train doctors in rural areas Dr Farhat Mantoo, Head of HR, MSF in South Asia, raises concerns about the shortage of doctors in the rural areas and provides strategies to attract the much need talent, in an interaction with Raelene Kambli What are the reasons behind the shortage of doctors working in the rural areas of India and how to address it?

There are multiple reasons for this reluctance: ◗ Medical education in India is very expensive: According to the Medical Council of India (MCI), 52125 students graduate every year from 412 medical colleges. A significant number of these students graduate from private medical colleges, many of which charge illegal donations, or ‘capitation fees.’

Since medical education from such colleges comes at exorbitant prices, graduates naturally seek lucrative jobs over jobs in rural areas that pay less. ◗ Government hospitals are understaffed: The doctorpatient ratio results in a strain on tertiary healthcare services.

We need to find a balance between centralisation and decentralisation of services without compromising on quality. The medical system in India needs an evaluation to understand if this is the best model given the population size and geographical spread. ◗ Poor working and living conditions in rural areas: Lack of adequate funding is the biggest reason for poor health infrastructure development that prevents doctors from serving in rural areas. ◗ Syllabus: Medical colleges do not offer a community-oriented syllabus. ◗ Reluctance from medical students: Medical students are not ready to accept ruralserving projects for many reasons. These include: ■ The pressure to pursue a

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specialisation; ■ Repayment of hefty loans; ■ Dearth of quality faculty; ■ A higher degree (MD degree) requires a medical student to dedicate comparatively more time than students pursuing other professions; ■ Security issues in conflict areas; ■ Internship in rural areas does not give the student the chance to interact with senior professionals due to understaffing.

Are there any programmes conducted by the govt to talent toward public health?

If yes, how effective or ineffective are these?

Several strategies have been employed by the Government of India and different states across the country in order to improve the situation of human resources in health systems.

For instance, a popular scheme of reservation of post-graduate seats for those serving in the public sector was introduced in several states (Shroff et al., 2013). The National Rural Health Mission (NRHM) was established in 2005 with a focus on improving healthcare in the rural areas of India (Sundararaman and Gupta, 2011).

NRHM has introduced special allowances for medics working in insecure areas including hardship allowance and performance incentives, among others. Further, NHRM realised that regular compensation is not enough and supplemented it with incentives. For instance, the Chhattisgarh Government in partnership with Public Health Foundation of India (PHFI) worked on an

Family Welfare (MoH&FW) allows doctors to pursue a private practice alongside reporting to Primary Health Centres (PHCs) just twice a week. Further, doctors working with MoH for 5-6 years are also sponsored to pursue their Masters degree. Recently, MoH&FW announced that contractual doctors who complete three years will be become permanent.

Improving the quality of personal and professional experience is equally important to motivate youngsters to work in remote locations initiative to get doctors and medical staff to live and work in districts torn by left-wing extremism. More autonomy to district collectors and access to flexi-funds such as National Health Mission (NHM) and district mineral funds (DMF) have made it possible for them to offer specialists salaries that are two-and-a-half to three times what they’d get elsewhere.

The Ministry of Health and

Do you think that including public health as a part of medical education can be a good idea?

Service orientation is the core of medicine and the medical fraternity engages in various ways to contribute to the society. The fraternity’s work in rural parts is one of them.

The first step should start at an early stage i.e., during medical studies. This is where the faculty/senior doctors should not only start talking about working in rural areas but also walk the talk. Every senior medical doctor should earmark one month in a year to coach and train doctors in rural settings. A doctor’s work in rural areas needs to be showcased and more success/ human stories need to be presented using different media.

Improving the quality of personal and professional experience is equally important to motivate youngsters to work in remote locations. Proper briefings to manage expectations and sufficient support on the ground can in still in young doctors the knowhow and confidence that their actions can prove the difference

between life and death.

Your recommendation to attract doctors to work in the rural areas?

Health and technical infrastructure in rural areas needs to be improved and the idea of service orientation needs to be re-invented. Some states have come up with innovative approaches. I think the key is to engage with initiatives such as the Association of Rural Surgeons of India to understand how to make work in rural India equally rewarding and professionally challenging. The below recommendations are based on MSF’s experience of sustaining an adequate pool of doctors: ◗ Yearly trainings, promotion, holiday and relocation policies should be employed to retain and attract quality staff. Here promotion policy can be viewed in two ways- a) performance and b) experience. ◗ Create a pool of professionals who can work on short interim positions throughout the year (contracts can offer short-term consultancy services) and offer mobility (the doctors can work in different projects in India and may also get an opportunity to work internationally). ◗ Invest in basic living conditions of medical doctors as there is not much recreation in rural areas. ◗ Involving medical professionals in training local staff, recruitment, and patient management can create a sense of belonging to the project. ◗ Facilitate family postings to attract experienced doctors and specialists. raelene.kambli@expressindia.com

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I N T E R V I E W

Social entrepreneur is all about having passion for change and growth of the society Healthcare startups with their vision to solve India’s pressing healthcare challenges such as accessibility, affordability and reliability of health services need to step in and offer evidence-based solutions for public health. LiveHealth is one such organisation which with the concept of social entrepreneurship intends to make a change. Abhimanyu Bhosale, Founder, LiveHealth in an interaction with Raelene Kambli explains this concept Who is a social entrepreneur?

And why is it an important concept to be discussed in the public health domain?

A social entrepreneur is a person who’s focus and passion would be more on making an impact in a society, culture or environment. It is very important in public health. People are not going to do great work and make an impact if they don't have the passion for what they do and especially in a not so rewarding segment of the market.

How would you define the concept of social entrepreneurship in healthcare?

Well, entrepreneurship in itself is a path chosen to focus more on the impact of the organisation’s products and work on the society in some way or the other. So, I think every genuine entrepreneur is a social entrepreneur in passion for change and growth of the society. Indian healthcare is very different from other healthcare eco systems. Here, we need a very different approach towards innovation and implementation to improve the lives of people availing healthcare services.

Some call it frugal innovation but it makes this sound less important or cheap. The real healthcare challenge that India faces as a country of 1.2 billion people is to work with a healthcare system which is hugely dependent on private organisations and public private partnerships for healthcare

than any other country in the world. Yes, we need social entrepreneurs in healthcare who see this as an opportunity and a problem worth solving. But, do we have enough incentives to keep them going? This is the questions we all need to answer.

What impact can this concept have on creating a healthy ecosystem for startups to function within the public health domain?

Honestly, it is very difficult for startups to function in the public health space. Moreover, it is difficult for startups to work in this space with little or no incentives. Nonetheless, there are companies who do their bit, though there are some social drivers which have big impact in the eco-system. Like startups working on improving breast cancer screening are doing a great job. Still our healthcare ecosystem really needs a lot of these people. Unfortunately, we struggle with the most primitive problems which is lack of data and actionable information. Right now, we don’t know our numbers, for e.g. how bad the dengue was last season? What is the number of women detected with breast cancer, and what's the average age group its generally detected in? What is the number of people who are prone to diabetes and how many already have it? Lack of these numbers blind us in our quest to have a better healthcare.

Change the way healthcare is managed in this country. Make it more transparent, information driven and better Tell us about your startup’s contribution in this regard.

LiveHealth is a company built to solve one of the biggest problems in healthcare. With a vision to make healthcare interaction seamless with the use of technology. One of our products happen to be the

biggest diagnostic and laboratory management solutions in the country. With over 450+ healthcare providers using the platform to manage patient and medical records, interact with medical instruments and share medical records with patients and doctors, we are making healthcare information management simple, liberal and free. We also work with charitable organisations and NGOs where we help them avail our management services at a much affordable rate and completely automate their laboratory operations, thereby reducing errors and man power involved. This also drastically reduces their operational costs as skilled personals in healthcare is the key driver for higher costs and automation will only make it more affordable.

What lessons can social entrepreneur teach public health workers and the healthcare industry at large?

Entrepreneurship is more experimental and procedural.

One of the areas where public health workers lack is organised execution of their ideas.

There are many people with better ideas in public health space, but nobody wants to get their hands dirty. So the difference is social entrepreneurs execute their ideas and that's what differentiates them.

What are the basic principles for efficiently implementing

scaled operations in public health?

Well, first is a great team.

Core team where team members trust each other and are capable to execute, get things done and adapt to change. After that, a system. A system or an operational process that works at a small scale, but which is built keeping in mind the large scale challenges. And the system should always consider user feedback and adapt based on that. So, if the core team is adaptable to change, they are able to execute and always listen to their customers, there is no way to fail.

Can you name a few social entrepreneurs that you look up to?

Dr Verghese Kurien, the founder of Amul and Dr G Venkataswamy founder of Arvind Eye Hospital for the obvious reasons as they have built successful empires from social entrepreneurship.

What will be your message for those who want to work with this concept and contribute to public health?

India needs people like you to come up and change things.

Change the way healthcare is managed in this country. Make it more transparent, information driven and better. We bear the responsibility of improving healthcare for 1/7 th of the world . Let us take that very seriously. raelene.kambli@expressindia.com

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‘SightLife is on a mission to eliminate corneal blindness globally’ Sight Life, a non-profit global health organisation is working on a mission to eliminate corneal blindness by 2040. Claire Bonilla, Chief Global Officer, Sight Life, in an interaction with Prathiba Raju, speaks more on their ambitious goals and emphasises on the need for a wellrounded strategy in India to eliminate corneal blindness After 20 years of managing various global functions for software giant Microsoft, how do you perceive this switch to SightLife?

For me, the transition personally was success to significance. I worked for 15 years with Microsoft and raised up to various ranks. I was successful in getting international market development, global business and PPPs. Though I have come this far, I learnt so much and have been successful, I was wondering how to lead a life with significance. I wanted to deploy the skills I acquired and make an impact, that is the reason I chose SightLife, which has taken up a mission to eliminate corneal blindness by 2040. It is an opportunity where I’m actually working to eliminate a disease in my lifetime. As a quote goes, ‘if you love your job, you will never work a day in your life’ and that is truly how I feel about my work here. It is incredibly meaningful and all of us working in SightLife think of making a difference.

Can you tell us more about SightLife and its mission to eliminate corneal blindness?

SightLife is world’s leading eye bank, and the only non-profit global health organisation, which is focussed solely on eliminating corneal blindness around the world. We have set a goal to eliminate corneal blindness by 2040. Corneal blindness is a condition caused by an injured or diseased cornea, the layer of tissue that covers the front of the eye. Primarily, we focus on

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having excellent eye banks, which we have already achieved in the US. In 2015, the US had performed 50,000 transplants and 65,000 corneas were collected. In the US, no one waits for a cornea transplant; if one needs a transplant, it is done the next day. It is seen nowhere else in the world. During May 2015 and April 2016, 22,858 transplants were done. Armed with the learnings on how to maintain world-class international standard eye banking, SightLife is now on a mission to eliminate corneal blindness globally.

Where does India rate in the list of corneal blindness?

There are about 10 million blind corneal cases in the world, with 98 per cent of those in the developing countries. Out of it, 5.6 million cases are in India. So, the country stands the tallest in corneal blindness. There is a massive gap between supply and demand of corneas.

SightLife started its operations in India in 2009. We started with 3900 transplants and by 2016, we have done 13,500 transplants, with our partners. Though India has talent and an amazing capacity of eye surgeons as well as eye hospitals, the country lacks best practices, training and tools. There is a dire need of right policies and each state should create a favourable ecosystem. For example, right from a donor registry to educating the community to encourage donation is needed.

SightLife is trying to partner

Though India has talent and an amazing capacity of eye surgeons and eye hospitals, the country lacks best practices, training and tools.There is a dire need for right policies and to create a favourable ecosystem to help India eliminate corneal blindness with high-mortality hospitals and eye banks, to teach them efficient eye-banking operations along with achieving high-quality standards, during retrieving corneas and accessing them to ensure better patient care and follow up care.

Tell us about your partners and your engagements with

various state governments?

SightLife has partners across eight states. At the national level, we work with National Program on Control of Blindness which is a part of the MoH&FW and with Eye Bank Association of India, where SightLife helps them to streamline their eye banking system. For example, we pro-

vide them with technical support and conduct capacitybuilding certification programme, which helps them increase cornea transplants.

Our partnership with the ministry and eye association is not just to create those programmes, but to effectively roll them out.

SightLife is also looking at the minimum quality standards that need to be in place for eye banks to operate and how to build financial sustainability for the eye banks. Currently, the eye banks in the country are reimbursed with fraction of cost which is 12 percent. So, a better reimbursement and compensation for eye banks is what we are asking from the state governments. At the state level, we are trying to build one or two large eye banks in a state which would work as a hub, with quality and precision. The Government of Andhra Pradesh has shown interest in creating hub-and-spoke model. SightLife has proposed to have three eye banks in Visakhapatnam, Vijayawada and Tirupati instead of 13 districts having 13 eye banks.

What kind of policies should be in place at the central level to help the state governments engage better?

There are some core policies that need to be put in place. A simple mandatory notification of death will help the cause in a big way. For example, to get 100,000 corneas, you will need only one per cent of all mortalities in India. But when death

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happens, the number of opportunity for consent and recovery of the tissue is less in India. So, mandatory notification of death will be one important policy, followed by honoring the first consent of eye donation. Many a times, after the death of the person, even if the deceased was willing to donate his/her eyes, the relatives do not honor the person’s wish. To overcome this, we need a proper donor registry. Apart from it, hospitals here should have mandatory cornea recovery programmes, which allows eye banks to conduct and train eye-donation camps within hospitals, so that they can meet the family and get their consent for donating eyes of the deceased.

Which developing country has made remarkable progress in eliminating corneal blindness?

Taiwan and Sri Lanka to follow are progressive in formulating favourable policies on corneal blindness. Taiwan will now have a trained technician to recover the tissue to get quality retrieval of tissues.

They are also working on bringing two national eye banks which will fund and reimburse the other smaller eye banks, and also look after quality standards.

Do you have any Indiaspecific targets to eliminate corneal blindness?

In 2002, the Government of India took on a very aggressive target of performing 100,000 transplants by 2020 to end the corneal blindness.

However, by 2016, the government completed 22,858 transplants and in the remaining four years, a four-fold growth is required to achieve the expected target for 2020. As a whole, the country has 750 eye banks but most of them exist only on papers. There are 160 operational eye banks, out of which close to 125 are functional where 22,858 transplants have been conducted.

Meanwhile, SightLife, with its partners in eight states, is actually growing much higher in percentage in corneal eye

SightLife is setting up an eye bank through PPP with KGMU in Uttar Pradesh transplants than the government with 11,947 transplants, which is more than 50 per cent. Now, we are working to create highperforming large eye banks. If we have large eye banks partnering with hospitals in nearby localities, there is no need to travel long distances for the recovery of the tissues.

SightLife is setting up a stateof-the-art eye bank through PPP with King George Medical University (KGMU), Uttar Pradesh, the largest hospital in the state, which has a record of 4,000 mortality rate. The trained dedicated staff at eye banks will get access to hospitals, ICUs, trauma wards. Besides, each death would be notified and

counsellors would try to convince the relative of the deceased for a cornea transplantation.

The new eye bank will also create linkages with other hospitals in Lucknow and surrounding districts within a radius of 100 kms, to retrieve corneas and make them available for transplantation.

Sightlife is also looking at a state-wide programme to link up hospitals with eye banks at the state level and to bring in policy changes.

Our idea is to focus on 10 key states and putting in effective systems like right policies, high-processing eye banks and central distribution systems. We will pick 10 states which have high mortality rates, so that we have access to more corneas. Our mission is to create high-volume eye banks, an effective distribution system, get more quality tissues that the local surgeons can use and build a robust corneal distribution system. Projections for 20202024 is 42,000 transplants.

Where does the money come from for SightLife?

SightLife has a myriad of donors. We don’t charge for our services. In many cases, we provide grants to eye banks to bring down the rates and making it easy for the initial investments. We get funds from major donors and The Hans Foundation is one of them. We also look for domestic and international funds.

Apart from it, we have SightLife staff-giving where everyone contributes some fund and participate in the noble goal. We have private companies like Alcon, Orbis who associate with us in our training programmes.

How different would be the first eye bank in UP? The world class state-of-theart eye bank in UP will have the best practices and over a time we would like to make it a centre of excellence, so that people from Asia can come and get trained. The new facility will conduct about 1,000 transplants by the end of 2018.

Besides, SightLife will also keep looking for opportunities to partner and open up more eye banks.

Is there a possibility to eliminate corneal blindness globally by 2040?

I truly believe it is possible. We need to take innovative and strategic steps and we are doing that. I have learned a lot from India and also opened an office in China. In 2018, we will start working in Ethiopia, which will mark our presence in Africa. We will also launch an online community and get three eye banks in the US, Vietnam and Thailand, so they can exchange ideas and also get access to the Standard Operating Procedures (SOP).

The recovery technicians will also get online training of the best practices to retrieve cornea. They can watch recovery videos and self teach to increase the quality levels.

This online forum will help in dissemination of information.

Using technology will be one of the areas we will have a robust growth by setting up webinars with our state partners like LV Prasad Eye Institute's eye bank manager. Apart from it, we will be creating centres of excellence in KGMU in UP (India), Taiwan and Sri Lanka. prathiba.raju@expressindia.com

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cover ) INSIGHT

Keeping the promise of patent bargain and affordable access to medicines in India

YOGESH PAI Assistant Professor of Law and Co-Director, Centre for Innovation, IP and Competition, NLU Delhi

Yogesh Pai,Assistant Professor of Law and Co-Director, Centre for Innovation, IP and Competition, NLU Delhi, in an article which draws from his submissions to the UN High-Level Panel on Access to Medicines (2016), highlights India’s current situation on access to patented medicines in the light of its compliance with IP laws, trade norms and public health IT HAS been widely noted that India achieved self-sufficiency in pharma drugs by way of a combination of several policy instruments, including the withdrawal of product patents for pharma products (19722005), which facilitated strong local generic production with diverse capabilities. However, as of 2015, only 584 Indian generic firms were able to comply with the stringent US FDA regulatory standards to ensure supply of quality drugs. Moreover, the shift from India’s generic prowess in small molecule (chemicalbased drugs) business to big molecule biologics (bio pharma) is a rather significant move that the Indian pharma industry will have to quickly make in the coming years since seven out of top ten selling drugs are biologics.

While the Indian biosimilar (copies of biologics) market, valued between $300-400 million is growing, how fast Indian firms manage to overcome the technical and regulatory barriers in order to capture the global export market is yet to be seen. While Indian firms are fast-tracking investments in innovation in the biosimilar space, it is time to reassess the dynamic role of patents in the context of access to medicines in India and the country’s continued ability to pioneer as ‘pharmacy of the world’.

The advent of the pharma product patent system since 2005 has led to a new scenario, both in terms of challenges to India’s generic industry and in ensuring equitable access to

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medicines. It has led to a general assumption that patent owning firms would be able to charge prices way beyond what is generally considered as ‘reasonably affordable’ for the Indian patient population. A recent study, however estimates, “a molecule receiving a patent experienced an average price increase of just three to six per cent with larger increases for more recently developed molecules and for those produced by just one firm when the patent system began.” The study further notes, “the presence of substitute goods should moderate the pricing power of firms receiving patent protection.”

Hence, text book cases of pharma patents serving as strict monopolies that lead to

significant increase in prices must be understood with appropriate caveats and caution in the Indian context. This is not to deny that there could be a steady or significant price increase in specific cases in the future depending on the nature of the drug, nature of the technology, disease burden, market size, domestic capabilities, barriers to market entry, drug regulatory challenges, availability of closer substitutes etc. However, to assume that patents in medical technologies, and particularly pharma patents, are always ‘overpriced’, or that there are no market non-distorting mechanisms to deal with pricing issues of patented drugs is a mistaken assumption.

There are several provi-

sions in the Indian Patent Law that places significant constraint on the ability of patent-owning pharma firms to engage in drug pricing beyond what is considered as “reasonably affordable”. These provisions have significantly benefitted the Indian generic industry and the patient population at large. In fact, it is quite possible that the very threat of onerous regulation may have significant impact on the behaviour of pharma firms in exploiting their patents in a way inimical to public interest.

India has remarkably emerged as a key country to experiment new models in balancing access issues by requiring the criteria of ‘therapeutic efficacy’ through Section 3(d) of the Patents Act, 1970 in

determining legal standards of patentability for a large class of incrementally modified inventions. The Indian Supreme Court has approved of such an approach in the famous case involving Novartis vs. Union of India (2013). However, it is a matter of fact that this provision has mostly been used in combination with other requirements of patentability (viz., novelty, inventive step and industrial application).

Although this provision is designed to contain ‘evergreening’, it has no doubt opened up early entry of generic drugs in the Indian market. While Section 3(d) has become a cause célèbre, how it plays out as an administratively manageable standard in terms of offering bright-line

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rules for the patent office will have to be carefully watched.

Similarly, India’s approach towards balancing patent rights and public interest is not divorced from procedural fairness. India is among the few countries which allow both pre-grant and post-grant opposition. These provisions provide broad standing for interested parties, including public health groups. It has led to streamlining of patent litigation where patents that do not muster the strength of patentability and patent-eligibility can be opposed at an early stage at the Indian patent office, without resort to proceedings in the courts and tribunals. Since the patent system is designed to achieve efficiency by aligning it with the market incentives of competitors to challenge patents, such additional avenues indeed help to weed out questionable patents. This improves the public notice function of the patent system and facilitates early entry of generic drugs.

Importantly, Indian patent law limits injunctive relief (but on payment of reasonable royalties) in cases involving infringement of mailbox patents (product patent applications made between 1995 and 2005 due to transition arrangements in TRIPS) where substantial investments were made prior to the publication of these applications. This may be one among the several reasons for the availability competing substitutes for existing mailbox patented drugs in India. Indian patent law provides a broad regulatory review exception (facilitates early entry of generics), research exemption and limited exceptions for importation and use of patented products for and on behalf of the government for the purposes of its own use, including use in hospitals notified by the government in case of any medicine. Of course, there is much to be desired in terms of the actual scope of these provisions owing to lack of judicial guidance. However, these provisions definitely point towards India’s concern for providing access to patented

Along with the availability of broad based grounds for third party compulsory licences, Indian Patent Law has provisions to invoke compulsory licences in cases of national emergency, circumstances of extreme urgency and public noncommercial use technologies. India’s patent law distinctly provides for international exhaustion.

India has not only used the threat of compulsory licences to force firms to engage in voluntary licences and price discrimination, it has been actually able to successfully grant a compulsory licence to bring down prices and to induce local working in line with the conditions prescribed in the TRIPS Agreement. These provisions offer a wide latitude for any person interested (with a capacity to exploit the compulsory licence by local manufacturing) to apply for a compulsory licence anytime after three years from the grant of a patent. So far, India has granted one compulsory licence on Bayer’s anti-cancer drug Nexavar (sorafenib).

Notwithstanding the presence of an infringing product of ‘Sorafenib’ marketed by India’s generic major Cipla at a competitive price, the Indian courts proceeded to confirm the grant of a compulsory licence. This decision, which has been confirmed by India’s highest court, has far reaching implications on patent holders’ ability to charge unreasonable prices since it has treated grounds for compulsory licensing as amounting to legal obligations on the part of the patent holder in ensuring equitable access.

Importantly, along with the availability of broad based grounds for third party compulsory licences, Indian Patent Law has provisions to invoke compulsory licences in cases of

national emergency, circumstances of extreme urgency and public non-commercial use. While there is wide latitude in terms of the actual scope of these provisions, India’s attempt to invoke these provisions is at a preliminary stage. Although India’s Ministry of Health is been seized of the matter since 2013, it has offered little guidance on the class of drugs which could fall within the scope of these provisions leaving patent owning pharma firms to regulatory uncertainty. Perhaps, the threat of a compulsory licence is among the reasons that have led to a host of pro-access measures by certain sections of patent owning pharma firms in India by way of differential pricing and non-exclusive licensing. Apart from its positive impact on affordable access to medicines, these voluntary measures undertaken by pharma firms not only bring new competitive synergies in the market, but are responsible for building sustainable local capabilities.

Some firms also engage in patient assistance programmes to ensure access. However, beyond such measures, further empirical studies outlining the actual impact of such voluntary measures will provide evidence into the practices of pharma firms in providing affordable access to drugs.

There is a strong regulatory turn in ensuring affordable access to biologics. Sustainable production of biologics highlights pertinent questions on potential barriers to access

created by technical barriers and strong drug regulation.

Unlike small molecules, which involves chemical-based drugs, ‘biosimilars’ or ‘follow-on-biologics’ raise complex technical and regulatory questions in balancing quality with equitable access. Unless optimally designed, regulatory standards potentially exclude competitors from the market. Although India has limited capacity in the production of bio-drugs, some firms are making attempts to break the barriers by experimenting new business models to synergise and overcome technical and regulatory barriers. However, litigation in these areas shows that regulation can be formidable a challenge to early entry of biosimilars. Similarly, regulatory pathway for biosimilars in a major export market like the US is still a major challenge for the Indian industry.

It is important to note that not all measures which are termed as ‘TRIPS-plus’ have their genesis in international intellectual property agreements. There is evidence in the Indian context that some of the provisions in her patent law that move beyond the common minimum standards of the TRIPS Agreement were unilaterally designed. They specifically relate to enforcement of patents. In fact, Bilateral Investment Protection Agreement (BIPA) that constrains the regulatory space on several intellectual property issues was liberally signed by India without recourse to its implications on intellectual property standards. India’s recent Model BIT is an example of unilateralism where it has agreed to expose its patent law standards to the test of TRIPS consistency in the context of investorstate arbitration. The reason for legislating such provisions may be have been due to pressure from diverse stakeholders and the continued relevance of intellectual property as a policy instrument to attract foreign direct investment. This is despite recent attempts to restrict regulatory power of States by way of designing TRIPS-plus stan-

dards in the Transpacific Partnership Agreement (TPP), to which India is not a party.

The above is notwithstanding the existence of systemic issues of drug innovation and access that move beyond pure questions of misalignment or policy incoherence between international intellectual property norms and other international obligations to ensure equitable access. Such systemic issues are widely noted in the area of neglected tropical diseases. There is evident market-failure in the ability of the patent system to offer enough incentives in the absence of a viable commercial market for neglected diseases. Different policy options have been articulated to delinking R&D costs from product pricing. India’s open source drug discovery (OSDD) programme of the CSIR in the area of anti-tuberculosis drugs is an attempt worth studying in greater detail to understand the advantages and pitfalls of such a model. Another significant issue that has not been addressed by policy makers is in relation to the risk shared by universities and publicly funded research institutes in bringing out valuable inventions and its consequent implications on pricing of such drugs. The existence of structural bottlenecks in emerging economies also contributes to raising barriers to equitable access to medicines. Higher budgetary allocation by states may have positive outcomes on healthcare and in ensuring equitable access. Wide-spread popularity of health insurance schemes can signal positive outcomes for access to medicines. All these options go on to emphasise that patents are not the single most or even a major determinant of economic constraints for access to medicines. Hence, as we experiment with new models for drug innovation by delinking R&D and pricing, it is doubtful if the patent system stands in the way of such alternative measures to address systemic issues in healthcare since these measures exist outside the scope of formal IP protection.

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STRATEGY I N T E R V I E W

‘We have been very aggressive in online marketing’ Kaushik Shah, Director, Hemant Surgicals, talks about the opportunities for the company in India, the challenges they face currently and their strategy to thrive in this highly volatile market situation What was your thought process while establishing Hemant Surgicals?

Hemant Surgical Industries was established in the 1987 with a vision to promote quality and affordable surgical products in Indian market. We are the agent of JMS Singapore and JMS Japan which is a public listed company in Japan. Their company profile includes manufacturing of high-end adhesive surgical tapes, disposables pertaining to blood transfusion and infusion therapy, haemodialysis disposables and many other quality products to pen down.

With sincere efforts over past 25 years of Japan Medical Supply (JMS) and Hemant Surgical Industries, the company has built a trust and benchmark of providing quality products and it’s very well accepted across national level.

The end users and customers are satisfied with the high precision quality. Besides JMS, we are pioneer in importing Refurbished haemodialysis machines providing 24 X 7 services back up which is economical for dialysis centres. Due to affordability and prompt service we have achieved a benchmark of more than 1000 installations across with satisfactory results. The company also provides dialysis disposables which are imported and manufactured by our self. We have also diversified its vast range into urology and respiratory and other hospital care devices.

Can you throw more light on your rent concept?

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As the dollar value is soaring high and import duty is also unfavorable the cost of life saving products are getting expansive so we offer these products on rental service to the market in order to enable nephrologist to bring down the cost of dialysis and other related services. Apart from this we also intend to import cardiac products and equipment and rent it out to the medical fraternity. This is helping them save cost on buying high end equipment. Besides this, we also have plans to export injectable products which we are currently manufacturing at our Achhad plant. We are also going in for a WHO certification for manufacturing and outsourcing of these products to make it affordable to the Indian as well as global markets.

How many sales offices do you have in India?

We have three register sales offices in India (two in Mumbai and one in Delhi) and two manufacturing plants in Maharashtra.

What are your dealer networks? And who takes care of your after sales services?

We have around 300 dealers across India for making our range of products available to the end users and medical fraternity. Due to our presence for more than 28 years, all the leading most cardio and nephrologist are our key opinion leaders for guiding us to develop quality products and are also our customers for using our cardiac and nephrol-

sector?

With the growing GDP and population we find immense opportunity in Indian healthcare sector we are very positive about the growth prospects of this industry. Being in the sector since 1987, we believe that the sector is poised to grow at a CAGR of 15-20 per cent per annum.

The company plans to focus on online marketing with the help of leading marketplace portals like Amazon, Flip kart etc., to reach end users ogy range. We have our service team of 28 bio-medical engineers for servicing of haemodialysis machines and other medical equipment.

What opportunities do you see within Indian healthcare

What is your strategy to tap the Indian market?

The company plans to focus on online marketing with the help of leading marketplace portals like Amazon, Flip kart etc., to reach end users. We have been very aggressive in online marketing and have kept are pricing extremely affordable. We are also investing in print advertising such as healthcare magazines which have the right target audience.

What are the challenges you face in Indian healthcare market? What is the need of the hour?

The biggest challenge we face in the Indian healthcare market is obtaining any license within time frame for manufacturing and importing the product. The government system has to be more transparent and efficient and there has to be a single window system for procurement of the license.

The present government is focusing on made in India concept that is local manufacturing by imposing heavy import duty on imports. Besides there is no stability and import risk due to heavy fluctuation in the exchange which makes Imports very difficult. As a im-

porter our biggest challenge will be to bring affordability and economic viability for marketing our products in front of local manufacturing.

Has the government demonetisation impacted your business?

We appreciate the decision taken by our prime minister for ruling out the corruption and black money but due to inefficiency of the bankers and other law of limitation, our customers finds it very difficult to withdraw their our money and do the purchasing in the surgical market from last three month we have seen 35-40 per cent down sales due to cash demonetisation.

What are your plans for 2017?

Any new product launches in the pipeline?

Our current Prime minister is emphasising on local manufacturing by providing several subsidies and on other hand import is getting unfavorable due to heavy duty structure.

Lifesaving products and needy products are unaffordable at times. Due to de-valuation of Indian rupee in front of other currencies, the situation is getting very tuff for imports in the view of the above we are planning to set up a local manufacturing with our principal for making our products more affordable and economically viable in front of local manufacturers.

The company vision is to bring quality healthcare, cardiac and lifesavings products in 2017.

EH News Bureau

STRATEGY I N T E R V I E W

‘On an yearly basis, we put up about 15 to 25 satellite labs’ Om Prakash Manchanda, Whole-time Director and CEO, Dr Lal Pathlabs, talks about the expanding network on his company and the future strategies for growth, in an interaction with Prathiba Raju

How did turning into a public-listed company help your brand?

Turning into a public-listed company for a year now has made our brand more visible.

So, trade partners and the employees associated are happy. It has also helped us attract talent. Certainly, it has given more focus to the business. Overall, it has done good to the healthcare industry because people have realised that diagnostics is also mainstream in the healthcare division. Diagnostics has taken its claim and will definitely help the healthcare industry.

Is the share of unorganised players a cause for concern?

Unorganised players have always been there. Hence, the competitive intensity of the unorganised sector will always have a role to play. We can't see any barrier in the opening up of a lab. Unorganised players will remain, they do compete with us on one level but at the same time they partner with us too. That partnership exists because they cannot do all the tests. Hence, they outsource these tests to us. That relationship does exist between these labs and us.

You will always require offline collection points. I look at these kind of labs and feel that someday they would come and partner with us to outsource tests in a larger proportion than what they are doing now.

What are the challenges you face during expansion?

On an yearly basis, we put up about 15 to 25 satellite labs.

These are smaller labs surrounded by one big central lab. One such big central lab is located in Rohini (Delhi).

Similarly, we will be setting up a huge lab in Kolkata which will be operational by September 2017 and another one in Lucknow will be operational by December 2018. These large central labs will be surrounded by smaller ones. As of now, we have 175 operational labs. On an yearly basis, we put up 20 smaller labs, and this plan will be revisited or revised once the bigger labs are opened. Each of the big labs will cost us `40-50 crores.

How is the cluster zone approach of Dr Lal Path Lab helping your business?

Cluster zone approach is like a hub-and-spoke model, we have an ecosystem in which one lab is surrounded by collection points. If you are in a big city, it is easier to grow in the contiguous market, rather than starting afresh into the nearby market. We had introduced a central lab in Delhi to make sure that we grow in and around other areas geographically like Uttar Pradesh, Haryana, Rajasthan and Punjab. We are creating two more big clusters in Kolkata; it will be the epicentre for us in the East, so that it will proliferate our

network like satellite labs and collection points.

How do you manage your samples in the international market?

We procure samples from Gulf, South Asia and African countries. Usually, there is a demand for high-end tests where the turn-around time is not that critically important, but the quality and price matters. The charge varies from country to country. It depends on the prevailing price points. Right now, we get samples from our collection points as we don't have a ground testing lab.

Dr Lal Pathlabs is constructing a two large labs, one in Kolkata which will be operational by September 2017 and another one in Lucknow which will be operational by December 2018.

Each of the big labs will cost around `40 to 50 crores

How technology enabled is your diagnostic chain?

What are the new innovations that you have introduced?

Technology is a very important part of our business.

There is no need for patients to visit a lab and there is home collection and online collection of the patients’ report. We have launched an app through which they can book an appointment, make payments online and download their current and previous reports. Currently, the model is the same but we are trying to augment our infrastructure of labs and collection centres. We tend to penetrate those in the tier II and tier III towns. Though, it all depends on what phase the market is in. prathiba.raju@expressindia.com

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KNOWLEDGE INSIGHT

Strengthening India’s senior living care continuum

ABDULLA KAGALWALLA MD, Signature Senior Living India

India's demographic is greying at an alarming rate. 110 million of the population is already 65 years +, projected to reach 170 million by 2025 and 240 million by 2050. Of the six million known cases of Alzheimer’s or dementia in India as of 2016, most are being taken care of by in-home care and home health care services, due to the lack of communities offering memory care services.

Thus, senior housing is an emerging opportunity area for the builder and development community.

Abdulla Kagalwalla, MD, Signature Senior Living India, a consultancy for the senior housing and living industry, examines the senior living and care options available in India

S

enior living in India is often wrongly referred to as an ‘old age home.’

Indian laws and various acts also carry the same terminology of ‘old age homes.’ The picture and perception of old age homes and therefore senior living is that of a grey and decrepit place run by charitable institutions for the homeless, destitute and elderly. The images that come to mind are not pleasant.

Coupled with this perception and lack of awareness is the associated cultural and social taboo of ‘not taking care of your parents or elderly’ if they were to reside in a senior living community away from home. These are the major causes that have stymied the growth of much needed senior living communities in India.

Let us look at ‘adoption’ from a different perspective and try to untie the knot that has kept Indian seniors from availing and enjoying world class senior living communities.

Provision of care for a loved elderly in familiar and comfortable surroundings of home with privacy and familial atmosphere is ideal. As they age, ensuring our parents or elderly loved ones independence for as long as possible at home is always the first choice.

However, there comes a time of objective evaluation where the level of care and assistance

cultural activities with personalised service of care and prepared meals as per their dietary requirements. Care and services are provided 24 hours, 365 days a year. With a host of amenities available, these communities ensure that the residents are engaged and live their retirement life with choice, dignity, freedom and independence.

Independent living

(Adopted from SeniorLiving.org)

required for your loved elderly cannot be effectively provided at home.

The key to healthy ageing is to extend the independence of the elderly for as long as possible. Extending independence is not just a mere function of provision of medical care or of assistance, but is of ‘overall wellness’ which includes social, physical, intellectual, spiritual and emotional stimulation and care.

In the simplest sense, ‘senior living’ consists of independent living, assisted living and

memory care housing and care services.

Apart from these, senior living and care spectrum include: ◗ Residential care homes ◗ Continuing care retirement communities ◗ Nursing homes ◗ In-home care ◗ Home health services ◗ Adult day care ◗ Respite care ◗ Hospice The senior living spectrum graphically relates acuity levels with senior service classification and corresponding costs.

Senior living communities are designed and purposely built to accommodate the varying needs of its residents spanning from being independent to requiring high levels of care (high acuity levels) in a resort type atmosphere geared to overall wellness and healthy ageing in place. The communities incorporate a host of equipment, appliances and technology to ensure the safety of its residents whilst ensuring delivery of care and services.

Residents enjoy a host of social, physical, intellectual,

Independent living as a form of senior living is suitable for elderly who are generally independent and carry the ability to do activities of daily life by themselves. When one refers to activities of daily life, it generally includes dressing, grooming, bathing, personal hygiene, mobility, medication management and other personal activities.

In an independent living atmosphere, seniors are attracted by the prospect of enjoying the companionship of same age group residents along with a host of services that allow them to live in a carefree environment.

Independent living comes in various flavours depending on the physical build, configuration and the services provided.

These are retirement communities, 55 + living, active senior communities, active senior living, senior apartments, retirement homes and comfort

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KNOWLEDGE homes.

In developed countries like the US, independent living is typically on a rental (lease) model with monthly charges based on the community and kind of unit.

dards and world class senior living services.

India is on the cusp of witnessing a dramatic shift in the very near future where early stage retirement homes concept is being replaced by full-fledged independent living communities.

Independent living in india India has witnessed a gradual emergence of independent living, mostly in the form of comfort homes, retirement communities and senior apartments.

Even today, a majority of the new developments are retirement home communities and senior apartments with a few being truly independent living communities.

Typically, most of the projects offer general security, general maintenance and housekeeping services with a club house for resident activities.

Dining services are available for residents on a chargeable basis.

Practically all projects have tie ups with medical facilities; most have on call doctor, community doctor visits and nurse stations manned by registered nurses.

However, as perception towards senior living undergo a change, so do the trends.

Growth of independent living in india The growth of independent living in India is directly related to its adoption by not only the Indian seniors but also by their families and loved ones. The pressing need for adoption is being driven by rapid economic development, changing socioeconomic and cultural factors.

This, combined with 110 million 60 + population growing to 170 million by 2025 and to 240 million by 2050 is compelling.

Awareness, a well-educated and globally connected senior population desirous of availing post retirement services and the breakdown of social taboo are factors that will drive demand.

The builder and development community has realised the impending explosion of this asset class. This was very evident at the National Conference of CREDAI in August 2016 held at Shanghai where senior housing was one of the two emerging opportunities focused on.

The supply side is witnessing new projects being introduced adhering to international stan-

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component covers the rent and meals whereas the level of care charges covers the resident care component for personal and other services provided. The level of charges varies based on the amount of care required.

The scenario in India Assisted living Assisted living is for seniors who require various levels of assistance with their daily activities of life. When one refers to activities of daily life, it generally includes dressing, grooming, bathing, personal hygiene, mobility, medication management and other personal activities.

Assisted living communities are an ideal solution to assist seniors to maintain their independence for as long as possible while offering them activities of daily life services. It is a great bridge to fill the gap between independent living and n nursing homes. It is by no means an alternative to nursing homes.

Seniors who are not in requirement of constant medical care, intensive care or skilled care but require intermediate or lower long term care are typically residents of assisted living communities. These communities work to ensure that senior residents continue enjoying a rich social and independent lifestyle filled with friendship, activities and events whilst providing benefits of having the extra care and support that they need round the clock.

The physical layout of assisted living communities are numerous ranging from tall buildings to flat single story structures depending on a host of factors, chiefly being the cost.

Almost all the assisted living communities have apartments of various sizes with attached senior friendly bathrooms in one or two bedroom configurations.

Redefining senior care Aassisted living is the fastest growing long-term care option.

Seniors who are still independent but anticipate needing care in the not-too-distant future typically select assisted living over their current home.

Assisted living communities recurring charges comprise two basic components namely; room and board and level of care charges. The room and board

The current availability of fully operating assisted living in India is negligible with a few communities spread thinly. There are less than 70 independent communities in operation and under development. However, there are encouraging signs of new assisted living communities being designed, developed, built and will be operated based on international standards which bodes well for Indian seniors.

Just as it is the fastest growing segment in the developed world, assisted living could witness the same trajectory in india.

India’s demographic, social and cultural changes due to industrialisation and urbanisation are giving rise to the ‘need’ driven assisted living services.

The growth in assisted living services is evident from the spurt of in home services organisations across major metro’s and tier II cities that have recognised the need and void and are offering at home assisted living services. The services offered are in the form of providing care givers and nurses for assisting the elderly in their activities of daily life at their place of residence.

It is but a matter of time, that India will witness a growth in assisted living communities that offer a comprehensive and whole ‘wellness’ package thereby addressing the need of senior’s requiring assistance while maintaining their independence.

In-home care and home health care services Care provided at home for a loved elderly is referred to as inhome care. In-home care has the advantage of being private and personal in the comfortable surroundings of one’s own home.

The type of care provided varies from person to person as also the frequency of care. Care is provided by caregivers (ward boys) and nurses and is typically non-medical in nature. In-home services are provided more pre-

ventively and are focused on helping the individual maintain independence and keep them at their optimal level of functioning by providing basic services and supervision.

Home health services are similar to in-home care where skilled nursing services are provided to the patient. Here the provision of services is by licensed personnel and generally cover pain management, infusion therapy, heart disease, psychiatric services, COPD, diabetes, chronic kidney disease, and oncology.

Both in-home care and home health care service provision is on the rise as an industry in india. Even in the space of senior living especially for assisted living and memory care, there has been a marked and significant increase in service offerings which are a direct result of the demand metrics that are being witnessed.

Memory care Memory care communities are designed and operated to take structured and programmed care of seniors affected with memory loss due to Alzheimer’s or dementia.

Dementia is impairment in cognitive function that affects memory, personality and reasoning. Alzheimer’s disease is by far the most common form of dementia affecting the elderly accounting for more than three quarters of all dementia cases.

The symptom progression is typically very slow occurring over an extended period of time.

With the progression of Alzheimer’s or dementia, the level of care and assistance a senior requires also increases.

At communities offering memory care, specially trained staff is available 24 hours a day to monitor residents and assist them with daily activities such as taking medications, bathing, grooming, eating, and dressing.

Care programmes and activities are geared specially to those with dementia, and may include art and music therapy. Skilled nursing care is also generally available to those who need it.

The physical design of memory care communities contain resident units in a secure area with the intention of preventing wandering off and getting lost

which is a common and dangerous symptom of this disease.

Memory care offers 24-hour supervised care with meals, activities and health management.

Charges are usually all inclusive consisting of room, boarding and care or separate with two major components being room and board and care level charges.

The India story In the past, majority of indian families failed to recognise dementia as a disease. The social and cultural taboo associated with the same prevented families from seeking appropriate guidance and importantly learning about care provision.

Today, dementia is recognised as a disease and there is an increased amount of awareness on the subject. There are six million known cases of Alzheimer’s or dementia in india as of 2016.

Today, most of the care for seniors afflicted with dementia is provided care at home. Apart from home care, there are some medical related institutions, spread thinly across the country, taking care of dementia patients on a long term basis.

Due to the lack of communities offering memory care services, care for elderly afflicted with various degrees of dementia is sought from providers of inhome care and home health care services. The need is evident from the growth of in-home and home health providers memory care offerings especially in metros and tier II cities.

However, there are encouraging signs of new assisted living communities with memory care wings being designed, developed, built and will be operated based on international standards which augurs well for indian seniors in need of these services. Senior Living Communities play a vital role not only addressing the needs and wants of its residents but also providing comfort to their families. Promoting overall wellness, they foster healthy aging in place with dignity, choice, freedom and independence. With increasing life expectancy and proportion of aging population in the next few decades, the growth and importance of senior living is inevitable.

KNOWLEDGE

REPORT

Ahealthy heart for all HHFA, an India Medtronic initiative, tries to address the key barriers to getting the right treatment which includes- lack of affordability, awareness, and appropriate diagnostic facilities in an integrated manner which includes- lack of affordability, awareness, and appropriate diagnostic facilities in an integrated manner HEALTHY HEART For All (HHFA) is an innovative and integrated programme that makes advanced cardiac care therapies available to everyone. Financial assistance is provided to implant heart devices such as stents, pacemak-

ers, ICDs and CRT-P, heart valves, and aortic grafts by partnering with hospitals. Research shows that the key barriers to getting the right treatment include lack of affordability, awareness, and appropriate diagnostic facili-

ties. HHFA, an India Medtronic initiative, tries to address all these challenges in an integrated manner.

One of key barriers for patients to receive quality treatment in India is their lack of capacity to afford the treat-

ment. As part of the HHFA program, India Medtronic has introduced a financing scheme loan to help qualified families cover the cost of devices required for the treatment. To help patients and their families, HHFA offers loans at easy

installments within 1-2 days.

The process requires minimum paperwork and entails no asset mortgage for availing loan facility. A unique feature of this model is that needy patients are provided quick loans so that they can get the device

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KNOWLEDGE

CASE STUDY Anand Redekar, 61-year-old retired teacher was leading a normal life with his family in Ratnagiri district. Few months ago while doing his daily household chores; he experienced some uneasiness in his chest, palpitations and dizziness.

Fortunately for him, being at home proved to be a boon as his family immediately took him to see a local doctor. Once there, he was given some primary aid and was referred to another doctor for further examination.

The doctor performed an ECG which revealed readings of ventricular tachycardia- a fast heart rhythm that starts in the lower part of the heart (ventricles). If left untreated, some forms of ventricular tachycardia may get worse and lead to ventricular fibrillation, which can be life-threatening. He was given an external shock therapy to quickly restore his normal heart rhythm. In this therapy , electrical shock is delivered through the chest wall to the heart through special electrodes or paddles that are applied to the skin of the chest and back. The goal of the procedure is to reset the heart to normal rhythm. Post this, Redekar felt

by paying as low as 15 per cent of the cost and the rest through equated monthly installments over a period of time.

Another significant challenge is being correctly diag-

slightly better.

However, he was recommended an angiography to find out the root of the problem but the test results did not reveal any abnormalities but the symptoms of uneasiness and shortness of breath were persistent. Eventually, he met a cardiologist in Ratnagiri who apprised him about Implantable Cardioverter Defibrillator (ICD) as a device that can help regulate his fast heartbeat. ICD is a device implanted to restore irregular and fast heart rhythms to normal.

Redekar’s son in law being a doctor, brought him to Aditya Birla Hospital in Pune wherein he learnt more about his condition as his heart’s pumping action had been damaged. It was putting him at a high risk of sudden cardiac arrest.

Looking at his age and in keeping with his medical history he was recommended a CRT-D. CRT-D combines the benefits of CRT along with ICD in one. A CRT device sends small, undetectable electrical impulses to both lower chambers of the heart to help them beat together in a more synchronised pattern. This improves the heart's abil-

nosed for the disease. Symptoms such as sudden fainting, dizziness, breathlessness, and chest pain are either ignored or confused with neurological or gastric disorders. HHFA intro-

duces new diagnostic technology that helps diagnose patients with unexplained fainting episodes. Free patient cardiac checkup camps and ECG checkups are organised

ity to pump blood and oxygen to the body. A CRTD device is an ICD enabled with Cardiac Resynchronisation Therapy (CRT) and helps in biventricular pacing i.e. helps both ventricles contract at the same time.

After patiently hearing the benefits of CRT-D, he and his family decided to go ahead with the implant. However, a more important issue at hand was arranging enough funds for the implant. He was then referred to a Healthy Heart for All (HHFA) representative who understood his financial challenges and counselled him on the EMI options, eligibility criteria and other important details.

Within few days, Redekar got a CRT-D implanted successfully and has been leading a healthy life ever since. He is back to his daily routine and feels more secure than ever before.

“I thank Healthy Heart for All for helping me in my time of need. The timely guidance and arrangement of funds made it possible for me to survive my serious heart condition”, said Anand Redekar.

on a regular basis in association with physicians. Additionally, dedicated patient counselors work closely with patients and physicians to ensure patients overcome any

barriers to receiving appropriate care.HHFA, through its direct-to-patient activities, tries to sensitise patients to identify cardiac disease symptoms in the initial stages.

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

KNOWLEDGE I N T E R V I E W

‘The Gokhale Method is unique in its efficiency’ Esther Gokhale, Creator and Founder, The Gokhale Method, has been involved in integrative therapies all her life. The Gokhale Method teaches simple techniques to restore the posture and movement patterns one develop as a child. In an interaction with Sanjiv Das, she talks about how Gokhale Method, has been able to address the root cause of musculoskeletal pain

How does Gokhale Method differ from the conventional methods to treat acute back pain?

The Gokhale Method is an anthropologically and historically informed posture approach to help people restore their primal posture and movement patterns. Once learned, it takes no time out of people’s busy lives, nor does it depend on special equipment or interventions by an expert. The Gokhale Method uses hands-on guidance, as well as visual and intellectual cues, to teach students how to sit, stand, bend, sleep, and walk in ways that strengthen and protect the body, as opposed to causing wear and tear or injury. The Gokhale Method is unique in its efficiency and its low demands on students’ time and resources.

What are the major advantages of integrating this method into current treatment protocols?

Many current treatment protocols provide band-aid solutions for symptoms, whereas the Gokhale Method addresses the root cause of musculoskeletal pain. It empowers individuals by giving them an understanding of their problem, techniques to align their bodies in everyday actions, and control over an important aspect of their health. The Gokhale Method

provides self-education that can help other interventions to be successful in the long term.

Can you cite some examples where this method has lead to significant impact?

I have taught thousands of people this method by now— and correspondingly have thousands of testimonials to share.

Many students report that the Gokhale Method changed their lives. A favourite example is the Indian violinist Kala Ramnath, who experienced such debilitating back pain that she considered her musical career (which is part of a line of seven generations of musicians), was at an end.

Since taking the six-lesson Gokhale Method Foundation’s course, she has experienced no pain whatsoever. She says “I have to pinch myself sometimes - a I really without pain?” Other favourite students are Joan Baez and Desmond Tutu because it’s a particular pleasure to help people who inspire a lot of other people.

In which countries are your method being used? Are there any plans to foray into other countries?

Trained, qualified Gokhale Method teachers can be found here in India, as well as in the US, Great Britain,

Mexico, Canada, Germany, Chile, Singapore, Australia, Italy, The Bahamas and Slovenia. I train new teachers every year - this method is needed globally and I accept student teachers from everywhere in the world, as long as they are passionate about helping people.

It empowers individuals by giving them an understanding of their problem, techniques to align their bodies in everyday actions, and control over an important aspect of their health.

The Gokhale Method provides self-education that can help other interventions to be successful in the long term

What’s your agenda on this visit to India? Any tie-ups with Indian healthcare providers in the offing?

India is my home country, and holds a big place in my heart. India is also home to many cultures that hold the key to the world’s back pain problems. I am here, this time in Mumbai, Delhi, and tribal Odisha, to learn what I can from people who have not yet lost their natural way of moving in the world. As far as working with healthcare providers, I have found it best to work at grassroots level with people who need this work, and wait for healthcare providers to approach us, which they have begun to do in the US, and will surely do in India after the work spreads. Neither modern urban people, nor healthcare organisations, can afford to not pay attention to an approach that is as successful, efficient, and fundamental as the Gokhale Method. sanjiv.das@expressindia.com

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INIMAGING INSIGHT

MR Elastography of liver - Arobust emerging technique Dr Parul S Garde, Consultant Radiologist, Global Hospitals, Mumbai talks about new techniques revolutionising the diagnosis and management of chronic liver disease

P

ast few decades have witnessed a major technological revolution in diagnostic as well as therapeutic aspects of medical science. As a practising radiologist in a tertiary care super speciality organ transplant hospital, I take this opportunity to write about one such revolutionary technique which has truly made its mark in the diagnosis and management of chronic liver disease MR elastography.

Techniques This MRI technique quantitatively evaluates tissue stiffness by propagating low frequency mechanical waves through the liver. It is performed using an MRI safe passive driver that is applied to the right upper abdomen and lower chest overlying the right lobe of the liver while the patient is being scanned in the MRI scanner.

The MRE sequence is carried out with four short breathholds and completed within one to two minutes, without the need for intravenous contrast injection.

An active driver generates low frequency mechanical waves (typically at 60 Hz) which are conducted to the passive driver through a long plastic tube. The passive driver vibrates and produces shear waves that are propagated across the liver. The wavelength of the propagating shear wave is directly proportional to the stiffness of the liver, that is, the stiffer the liver, the longer the wavelength.

By applying an inversion al-

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gorithm to the raw data, elastograms or stiffness maps that depict tissue stiffness are generated. Elastograms may be displayed in a gray scale or with a colour scale. The result is obtained by placing the region of interest on the processed images. It is measured in Kilo Pascals.

Applications Staging of chronic liver disease : Regardless of the etiology, chronic liver disease can progress from inflammation to fibrosis (reversible in early stages) and finally cirrhosis (irreversible). Liver stiffness measured with MRE increases with increasing stage of fibrosis. The increase in stiffness increases significantly with advanced fibrosis and cirrhosis.

MR elastography can non invasively detect various stages of fibrosis and thus obviate the need for liver biopsy, which has been the gold standard for detection, till the past decade. Patients who are treated in early stages of fibrosis stand a better chance of survival compared to those untreated, particularly due to availability of effective antiviral treatment for chronic viral hepatitis.

Quantification of fat content of liver Non alcoholic fatty liver disease is widely accepted as a cardiovascular and insulin resistance risk factor. Fatty liver is diagnosed when the intracytoplasmic fat deposition is found in greater than 5 per cent of hepatocytes. Till pres-

MRI based methods of hepatic fat quantification have proved to be able to reflect much smaller changes in the degree of steatosis ent times, histological fat analysis is a semi-quantitative method at best, with high rates of misdiagnosis due to sampling error.

Currently, there is no cutoff or limit where liver fat content is considered too much or harmful. However, it is foreseeable that as we understand this disease spectrum as there might arise a need to know the exact amount of fat in the liver for risk stratification or re-

sponse assessment. Hence, there is a need for more precise quantitative methods of evaluating hepatic steatosis.

MRI based methods of hepatic fat quantification have proved to be able to reflect much smaller changes in the degree of steatosis. Besides, the results thus obtained can be correlated with the patients’ body weights and serum alanine aminotransferase and aspartate amino-

transferase levels. This makes MRI ideal as an imaging biomarker for assessing response to treatment of fatty liver. In fact, recent papers have primarily used MRI as a means to quantify hepatic fat when studying the effects of prognostication and treatment of hepatic steatosis in relation to NASH and impaired glucose tolerance.

There are two primary methods of evaluation for estimation of hepatic fat fraction on MRI. The first is an imaging-based, Chemical Shift Imaging (CSI) method which takes advantage of the fact that protons (hydrogen atoms) in fat and water molecules are quite different in magnetic resonance properties and that the signal intensity of the liver at different time-points of image data acquisition (echo time) varies, depending on the concentration of water and fat.

The second method is MR spectroscopy (MRS), a purely quantitative method that measures the concentration of water and fat metabolites based on their resonant frequencies.

Potentially, by combining the fat quantification information with MRE findings, one may be able to diagnosis simple hepatic steatosis from NASH and NASH with fibrosis.

Quantification of iron Content : Iron overload cannot be detected reliably on any other imaging technique except MRI. Iron is a paramagnetic substance and causes rapid decay of MRI signal and gener-

INIMAGING

that it may fail in patients having moderate to severe iron overload, where the liver MRI signal becomes very low and hence undetectable. Soon this limitation of MR Elastography would be overcome with newer MR sequence such as T1 mapping that are part of research at the moment.

Another major drawback of this technique at this point is that it cannot differentiate inflammation from fibrosis. 3D MR Elastography and multifrequency MRE techniques are however underway, which would definitely help to overcome this drawback.

ally results in signal loss where it is found abundantly.

Quantification of the degree of iron deposition is important for two reasons: it influences the decision to treat and provides an objective means to monitor response to treatment.

In patients with chronic hepatitis C, liver iron overload is associated with disease progression and resistance to antiviral therapy.

MRI can be used to estimate the degree of iron deposition in tissues by virtue of the fact that iron accelerates T2 and T2* signal decays in spinecho and GRE pulse sequences respectively. In order to guide treatment initiation and therapy monitoring, a quantitative means of predicting the liver iron concentration (LIC) has been deviced.

Future

Advantages MR Elastography assesses the fibrosis by depicting the tissue stiffness over the entire liver cross section. This is unlike the ultrasound-based method of elastography, where in only a portion of the liver is interrogated. Similar drawback is with percutaneous needle biopsy, where in if a sample from the normal liver is obtained would give wrong results in a patient with cirrhosis / fibrosis.

Besides elastography performed with ultrasound has its drawbacks in obese patients or when the patient has ascites or colonic interposition between the liver and the anterior abdominal wall.

Even after the injection of MRI contrast agents, there has been no influence on the liver stiffness measured with MR Elastography. Thus, it is considerably flexible in its use in the clinical liver MRI protocol.

As it is the quantitative technique, MR Elastography has an advantage due to the fact that it has excellent intraobserver and inter-observer reproducibility. Thus it can be used as a robust tool for monitoring the disease progression as well as assessing the response to treatment.

Limitation Main limitation of the MR Elastography at the current time is

Advancements in image acquisition technology would reduce scan time and minimise respiratory motion artifacts. Instead of using conventional gradient echo pulse sequences for image acquisition, spin echo, fast spin echo and echo planar imaging methods may increase signal to noise ratios, potentially reducing the limitation of hepatic iron overload

At present MRE suffers from lower spatial resolution, especially compared to standard anatomic MR images of the liver. Hence, MRE technique is also undergoing several modifications and improvements.

Advancements in image acquisition technology would reduce scan time and minimise respiratory motion artifacts. Instead of using conventional gradient echo pulse sequences for image acquisition, spin echo, fast spin echo and echo planar imaging methods may increase signal to noise ratios, potentially reducing the limitation of hepatic iron overload.

The 3D MRE technique would be useful to estimate liver fibrosis burden and also focal liver lesions.

A multi-frequency MRE technique that can demonstrate changes in viscoelastic properties that can help separate inflammation, fibrosis and congestion is currently being developed.

MRE of the spleen is also underway with simultaneous evaluation of liver and spleen stiffness. Spleen stiffness correlates well with portal hypertension and is useful for prediction of significant varices Future role of MRE in combination with contrast enhanced MRI is likely to go beyond determining liver stiffness and will perhaps allow it to discriminate between the effects of inflammation, passive congestion and fibrosis.

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TRADE & TRENDS

Carestream Health unveils new medical imaging, healthcare IT products at IRIA 2017 Carestream booth was designed on the theme of Future of Imaging, wherein unique booth design and presentations coupled with new products on the floor offered experience of future of imaging in true sense

C

arestream Health demonstrated its expanding portfolio of medical imaging and healthcare IT systems at the 70th annual conference of Indian Radiological and Imaging Association, which was recently held in Jaipur.

Carestream booth was designed on the theme of Future of Imaging, wherein unique booth design and presentation coupled with new products on the floor offered experience of future of imaging in true sense.

The company displayed a compact, lighter-weight mobile Xray system, the CARESTREAM Motion Mobile System; its OnSight 3D Extremity System for orthopaedic exams; new digital X-ray detectors, floor mount DR system DRX Ascend System, CBCT CS 9300 for dental 3D imaging, Compact CR Print solution Flex CR System, DrvyView 5700 laser imager, PACS solution and a self-service MyView printer kiosk that will enable patients to print or share their radiology reports and medical images.

“A clear focus on understanding the needs of our customers and efforts to create the best products to serve those needs has been our approach in 2016. This has enabled us to develop MyVue Centre Self Service Kiosk, Onsight 3D Extremity System and MyVue PACS solutions and several other products. In 2017, we rededicate ourselves to strive harder to help our customers to carry out their responsibilities better than before,” said Sushant Kinra, MD, Carestream India.

Carestream’s healthcare IT portfolio includes a Unified

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Core architecture for its Clinical Collaboration Platform that enhances security as well as interoperability, and complements healthcare providers’ existing IT systems. This architecture delivers clinical image data acquisition, viewing, sharing and archiving, and allows healthcare facilities to add features as needed. Physicians can use the company’s Vue Motion universal viewer to easily view and share patient medical images and reports using mobile devices.

The MyVue Center SelfService Kiosk was unveiled in the presence of Dr Prabhakar Reddy, Dr Prabhakar Reddy, Dr Satish Bhargava, Dr Bharadwaj and Dr Anand Abkari. The Onsight 3D Extremity System was unveiled

by Dr Chidambaranathan, HOD, Radiology, Apollo Hospital, Chennai.

Apart from the above solutions Carestream’s growing

portfolio of diagnostic imaging products showcased at IRIA 2017 includes: ◗ The Motion Mobile X-Ray System can be used by a wide variety of hospitals, clinics, diagnostic centres and others.

Besides, it also helps mid-sized hospitals aspiring to make the transition from CR to DR, who are forced to hold back due to budgetary constraints. ◗ The DRX Core and DRX Plus detectors offer a wide range of benefits to the customers.

Since the DRX Core detectors offer a superb image quality at affordable cost, they are very useful for smaller imaging centres, urgent care facilities and speciality clinics. The DRX Plus detectors are lighter in weight, faster and more reliable than the earlier versions from the DRX family. With models for both general radiography imaging and dose-sensitive applications, DRX Plus Detectors will help customers to

elevate imaging performance to an even higher level. ◗ Likewise, the DRX Ascend System is designed for small to mid-size hospital radiology departments, imaging centres, clinics and specialists’ offices.

The system’s floor-mounted design saves space and reduces installation costs, while the wireless, cassette-size DRX detector provides exceptional Xray positioning flexibility. The DRX detector can be moved from the wall stand to the table and can handle tabletop exams.

Higher volume facilities may want to use two detectors to enhance productivity. ◗ Carestream’s Managed Print Solutions (MPS) has brought about a revolution in the system of ordering, purchasing and stocking of X-ray films. The system, which operates through a dedicated web-portal designed by Carestream’s team of specialists, has made the entire process completely

automatic. ◗ The Vita Flex CR System: The reason for its popularity include its compact size, userfriendly nature, option for the radiologist to carry out simple repairs onsite, and a miniPACS option to view images on the go. ◗ Also on display were the CS 9300, DryView 6950 and DryView 5700. The CS 9300 System is a three-in-one solution designed for both ENT and dental imaging that combines true panoramic imaging, CBCT technology and optional cephalometric (measurements of the head) capabilities. ◗ The Carestream DryView 6950 laser imager delivers the ideal mix of innovation, digital image quality, high image resolution and a fast throughput.

The DryView 5700 is an innovative tabletop imaging system that offers simplicity and affordability for healthcare facilities of all sizes.

TRADE & TRENDS

Siemens Healthineers India showcases SOMATOM go.platform CTscanners and MAGNETOM Sempra MRI system at IRIA2017 The SOMATOM go.Now and SOMATOM go.Up CT scanners are equally suited to newly established radiology departments and to expanding successful institutions

A

t the 70th Annual Congress of Indian Radiological & Imaging Association (IRIA) 2017, Jaipur, Siemens Healthineers presented SOMATOM go.platform CT scanners and MAGNETOM Sempra 1.5 T MRI scanner with a focus on offering excellent return on investment for radiology customers. With a new strategic direction, Siemens Healthineers aims to enable healthcare providers around the world to meet their current challenges and to excel in their respective environments. Through products and solutions designed to increase efficiency and to reduce costs, Siemens Healthineers is setting new trends in healthcare together with its customers – working under the motto 'Engineering Success. Pioneering Healthcare Together.'

The SOMATOM go.platform has an especially innovative way of fulfilling its customers’ desire for efficient workflows and a high level of flexibility: It can be controlled via tablet, which paves the way for an entirely new, mobile workflow. Users can control all routine examinations using just the tablet. The standardised work steps are designed so that the users can run the scan with just a few inputs.

Automated post-processing makes it even easier to operate the scanners. The standardisation also gives radiologists additional assurance with regards to the diagnostic quality of the images.

With the innovative DotGO automated workflow, MAGNETOM Sempra users can react flexibly to each case and to the condition of the individual pa-

MAGNETOM Sempra MRI system

SOMATOM go Up CT scanner

SOMATOM go Now CT scanner

tient, while standardising the exam at the same time. Special technologies for examining the brain, spine, and large joints, known as Dot engines that automate and streamline the workflow, are included with the scanner as standard for the first time.

They cover around three-quarters of the average examination volume and help users increase productivity and avoid unnecessary repeat scans.

“SOMATOM go.platform CT scanners and MAGNETOM

Sempra MRI system, both will help our customers expand their radiological portfolio, become more competitive and achieve consistent, user-independent quality,” says Vivek Kanade, Executive Director, Siemens Healthcare.

Contact details Rosebud Gomes, Siemens Healthcare, HC APC IND MSC 130, Pandurang Budhkar Marg, Worli, Mumbai 400018 Tel: +91 22 39677734 mailto:rosebud.gomes@siemens.com

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TRADE & TRENDS

Meditek Engineers: Reforming healthcare, inspiring life Meditek was established to provide unrivalled service and support for all medical equipment MEDITEK ENGINEERS is a privately-owned company led by a competent team with many years of experience in providing excellent service to both public and private hospitals. Meditek was established to provide unrivalled service and support for all medical equipment. We have an efficient infrastructure and highly trained and multiskilled staff to bring you a range of services to suit every situation. First generation entrepreneur Anil Phirke realised the need of quality production of medical equipment and established Meditek Engineers in the year 1989.

Meditek Engineers is an ISO 9001:2008 and ISO 13485 certified company engaged in the business of manufacturing and marketing full range of medical beds and furniture.

Ranging from five function motorised intensive care beds to operation theatre trolleys, we have solutions for every need of the hospital. Meditek Engineers is headquartered at Mumbai. The display showroom and manufacturing plant are in Ambernath near Mumbai and spans a pan India presence. With exceedingly superior hospital solutions, the company has also marked its international footprints in African countries.

The management The managing body of Meditek Engineering is a team of experienced domain experts. With a passion to deliver superior results, the company has complemented each other well.

The team’s proficiency encompasses all the factors, necessary for the governance of a successful hospital equipment manufacturing company.

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5101 - Five function full motorised ICU bed ◗ Easily removable polymer moulded head and foot end boards for easy access to the patients ◗ Minimum height of 420 mm for the convenience of patients to get in and out of the bed

5102 - Five function full motorised ICU bed ◗ Easily removable polymer moulded head and foot end boards for easy access to the patients ◗ Minimum height of 420 mm for the con-

◗ LED backlight on patient control to improve the visibility of control buttons at low light conditions ◗ Auto contour button on patient handset prevents the forces urging on the patients foot end while giving the backrest position ◗ Conveniently mounted nurse control

panel at the foot end of the bed enables the staff to easily control all the functions of the bed and to lock individual function of patient handset if required. Electronic CPR button on the nurse control ◗ Clear access to bed from bottom and top for effective bed cleaning. ◗ Heavy duty IV pole for syringe pump

venience of patients to get in and out of the bed ◗ Auto contour button on patient handset prevents the forces urging on the patients foot end while giving the backrest position

◗ Clear access to bed from bottom and top for effective bed cleaning ◗ Heavy duty IV pole for syringe pump ◗ Four non rusting 125mm dia. polyurethane casters 2 with brakes and 2 without brakes

TRADE & TRENDS A state-of-the-art manufacturing facility Being a solution provider for hospital equipment and allied components, from ‘Concept to Delivery’ Meditek Engineers' engineering and design centre is self sufficient in technology for conceptualising, developing, testing and manufacturing of related products. The company is proud to have developed a setup that is absolutely wellequipped and state-of-the-art as per global standards.

It offers a turnkey medical device manufacturing service that spans the entire supply chain from component procurement to distribution, all within a quality controlled environment. It generates, develops and refines the product concept to ensure that all the requirements for a commercially and technologically viable product are met.

Meditek takes pride in its full-fledged in-house manufacturing facilities such as ◗ Hydraulic shearing. ◗ Bending and pipe bending machine. ◗ Seven tank pre-treatment plant for metal surface treatment.

◗ Automatic conveyorised polyester epoxy powder coating plant. ◗ Modern assembly and welding set up with test laboratory.

The excellence thus acquired is aptly reflected in the performance and quality offerings of the company. It has developed a surprisingly unique range of advanced products required for the healthcare industry, making it the most cost-effective manufacturer of the

given product range.

5103 - Five function semi motorised ICU bed

ICU advanced care

◗ Polymer moulded head and foot end boards. ◗ Tuck type split moulded railings (Set of 4). ◗ Patient handset ◗ Electric actuators for backrest and height adjustment ◗ Manual operation for kneerest, Trendelenburg / Reverse Trendelenburg position ◗ Four non-rusting 125 mm dia.

Polyurethane wheels 2 with

These are technologically advanced, high-tech products built with perfection and precision. These beds have been envisaged considering the complexity of the ICU operations and the critical stage of the patients' health. It provides maximum comfort to the patients and efficiently support the latest healthcare practices.

brakes and 2 without brakes. ◗ Stainless steel telescopic IV rod. ◗ Four IV location. ◗ Body coloured PVC buffer on all four corners.

Contact details Meditek Engineers W-13(A) Additional MIDC, Near Hotel Krishna Palace, Ambernath(E) 421506, Thane, Maharashtra Tel: +91 251 2620200, 2620258 Mob: +91 98220 92808 email: info@meditekengineers.com

School of Health System Studies,Tata Institute of Social Sciences organise third convocation 26 students received Post Graduate Diploma SCHOOL OF Health System Studies (SHSS), Tata Institute of Social Sciences (TISS) recently organised its third convocation of Executive PostGraduate Diploma in Hospital Administration (EPGDHA) at Library conference Hall, Main Campus, TISS in Mumbai. 26 students received their Post Graduate Diploma. Prof (Dr) S Natarajan, Chairman, Aditya Jyot Eye Hospital was the chief guest.

Prof Sundararaman, Dean emphasised the role of TISS in bringing changes in the field of hospital and health administra-

tion over four decades. While delivering the convocation speech, Prof (Dr) S Natarajan stressed on the need to blend the teaching of Swami Vivekananda and practical knowledge to come up with creative leaders for healthcare industry. He emphasised to the graduating batch that through their continuous engagement with the alma mater, TISS graduates would be able to become torch bearers for hospital management and for the advancement of the nation and society at large.

Throughout the programme, the sense of pride

The ceremony ended with a ray of hope and joy that is sure to inspire the students and faculty of this institute in the years ahead

and achievement was visible among the students, the faculty and staff of the Institute.

The convocation ceremony ended with a ray of hope and joy that is sure to inspire the students and faculty of this institute in the years ahead. The speeches by dignitaries were followed by vote of thanks by Prof M Mariappan, Chairperson, Centre for Hospital Management.

The students had felt that the course had contributed significantly to their learning and developing practical skills in the field of hospital admin-

istration. However, it had also offered strong challenges to cope with while working and learning. Furthermore, few had mentioned that, “we knew it wasn’t going to be easy to cope up with the new environment and excel. This new start, however, helped us gain unique knowledge and experience that set us apart from our counterparts in other institutes.” The valedictorian emphasised that it was now the task of the graduated students as alumni to show professionalism in hospital administration.

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DiaSys India: Way forward for 2017 Sachin Singh, Strategic & Operational Marketing, DiaSys Diagnostic India, elaborates on how DiaSys Diagnostic Systems provides innovative solutions through its leading edge technologies, trusted by customers in more than 100 countries INDIA IS passing through demographic and environmental factor which is adding to the burden of diseases. There have been major improvements in public health since 1950s. Affordable diagnostic tools are now available which are highly effective, when used appropriately. Healthcare has become one of India’s largest sectors and is growing at a brisk pace due to its strengthening coverage, services, satisfying the requirement of customer with innovative and quality diagnostic tools.

DiaSys is synonymous with superior quality reagents and systems that are extremely reliable as well as user friendly and sustainable. Maintaining and strengthening our outstanding reputation is the guiding principle of our daily work. For over 25 years, DiaSys Diagnostic Systems recognises the need of customer for quality, increased workflow, fast turnaround time and provides innovative solutions through its leading edge technologies, trusted by customers in more than 100 countries. The company entered In-

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dia in 2014 and started manufacturing product which can be catered to the customer in mid segment as well. DiaSys’ top priority is to provide our customers with the best quality products and services.

India has highest burden of diseases which is dependent on number of factors which are interlinked such as age, changing lifestyle and rapidly evolving socioeconomic determinants like access to healthcare or the lack of it. The patient needs to travel from semi-urban or rural areas for seeking diagnostic help and treatment on health issues. Many a times patients do not have access to suitable medical treatment due to unavailability of diagnostic tools and dissuading factors like cost of travelling, added expenses of stay in TierI cities where the test is carried out. This adds to cost of diagnosis due to which many patients show reluctance to the idea of getting proper treatment altogether. This resulted in increased mortality and morbidity rates in country.

In several cases, diagnostic solution offered to the patients is

Sachin Singh Strategic & Operational Marketing, DiaSys Diagnostic India

also incorrect which can also lead increase mortality rate.

India's competitive advantage lies in its large pool of well-trained medical professionals. India is also cost competitive compared to its peers in Asia and Western countries.

The cost of medical test in India is about one-tenth of that in the US or Western Europe.

This has driven the attention towards increased rate of

medical tourism in India who can get the test done at economical cost.

With mission, DiaSys Diagnostic Systems emerged as a pioneer in the field of liquid stable reagents and has developed to an established provider of diagnostic solutions for the clinical chemistry.

The extensive range of DiaSys QDx POC products includes wide menu of test for a variety

of parameters for including infectious diseases. All DiaSys QDx POC tests have laboratory precision, are easy to use and give a quick turnaround time to results.

DiaSys Diagnostic Systems has three pillars- Reagents, Instruments and Point of Care.

DiaSys India is strategic arm of DiaSys Diagnostic Systems sfor Point of Care ranges of product. It has planned to work on strategic and innovative approaches of developing new diagnostic tools of superior quality which can be catered at mid segment laboratory.

DiaSys has future plan to open 'DiaSys House'- new factory and office in Mahape, Navi Mumbai where R&D team. QC, Manufacturing and HO can work in sync to meet the customer requirements for innovative and quality products.

Contact details DiaSys Diagnostic Systems Alte Strasse 965558 Holzheim, Germany Phone: +49 (0) 6432 - 9146-0 Fax:+49 (0) 6432 - 9146-32 Email: info@diasys.de

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BARIATRICS At Ease!

ISO 9001:2008 Certified Company

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NOVA Check BP12 Piece to Piece replacement warranty for one year for any technical defect Please take advise of the authorized medical practitioner before use.

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Blood Bank Equipments

Blood / IV Fluid Warmer

Plasmatherm Blood Donor Chair

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Blood Bank Centrifuge

Biological Refrigerator

Platelet Incubator with Agitator

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VISITECT® Malaria RDTs for the determination of HRP-2 & pLDH antigens for P. falciparum, P. vivax and other malaria species

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LIFE INSIGHT

Talent acquisition-A herculean task

SANJAY GWALANI Center Head, SMRC’s V M Salgaocar Hospital, Chicalim, Goa

Sanjay Gwalani, Center Head, SMRC’s V M Salgaocar Hospital, Chicalim, Goa, highlights the challenges in acquiring the right talent in hospitals that arise due to the huge paucity of professionals in India

I

ndia’s healthcare sector will grow at a compound annual growth rate of 16 per cent and is expected to be $280 billion in size by 2020, according to a leading news daily.

It is also expected that with the healthcare industry seeing a robust growth trajectory, workforce in the sector is expected to be at 7.4 million in 2022. The report also says that the investment opportunities in the Indian healthcare sector have increased significantly and is expected to be one of the most attractive investment targets for private equity (PE) and venture capital (VC) companies. The FICC-KPMG report said that medical tourism has emerged as a strong segment due to India's growing strength in healthcare delivery. Now the million dollar question is, “Where to find, forget the ‘Right Professionals?’ but professionals themselves.

The Healthcare Outlook Report 2015 states that 57 countries across the world, including India, face a critical shortage of trained health professionals such as doctors, nurses and allied healthcare workers. “This is a global problem affecting all countries in different ways, the greatest shortages are in the poorest countries,” says the report. It proves the fact that not only inanimate resources but also the animate ones are required to be procured as part of the project. In India, the report says, the problem is compounded by poor distri-

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bution of health professionals, 80 per cent of whom work in the private sector in urban areas. Inequalities in the distribution of health workers are highest among doctors, nurses and allied healthcare workers and have a significant effect on health outcomes. This dearth of qualified professionals is one of the major challenges for the Indian healthcare industry. The matter of concern is that there is higher concentration of medical professionals in urban areas, who account for only 30 per cent of India’s total population. An alarming figure of practitioners are unqualified, yet they service the ailing population living in rural and semi-urban areas with impunity. A huge number of nursing colleges in India are unrecognised and unauthorised by state nursing councils and the Nursing Council of India. They produce hundreds of nurses every year, who have no expertise or even basic knowledge of nursing care. Such colleges have mushroomed in the country in the last decade and hampering the entire system.

There is no data of or even a discussion on the hospital associated deaths due to unqualified professionals in the care delivery system. Another pertinent example is of radiology and imaging professionals across the country.

The greatest need for radiology and imaging professionals is in Uttar Pradesh (around 3,600 radiology pro-

fessionals). Other states witnessing these huge skill gaps are Maharashtra, Bihar, West Bengal, Andhra Pradesh, Gujarat and Assam followed by Delhi. The Indian market for medical imaging is multi-segmented and can be divided into private imaging centres, corporate and flagship hospitals, large academic centers, smaller private hospitals, corporations, government hospitals and state-run imaging centres. There is a significant requirement for radiology and imaging professionals in all these categories. Since 2013, a concrete effort has been made to organise and upgrade planned courses and further diversify standards of practice to improve the quality of medical streams. Some good initiatives such as Pradhan Mantri Kaushal Vikas Yojana (PMKVY) have been launched to foster the healthcare workforce but a lot of work still remains to be done.

WHERE TO FIND PROFESSIONALS The Healthcare Outlook Report 2015 states that 57 countries across the world, including India, face a critical shortage of trained health professionals such as doctors, nurses and allied healthcare workers

The government needs to play a crucial role in the development of this work force through the promotion of new skilling schemes and monetary incentives for youth to enroll in vocational programmes and bridge the huge shortfall of workers in the industry.

The Ministry of Health, Government of India and the same under various state governments must motivate and provide monetary aid to corporate hospital set-ups and other private, semi-private, funded and individual ownership hospitals to set up more and more vocational institutes. This can be tried initially with nursing institutes and then furthered to technical institutes in the fields of lab technology, radiology and other diagnostic technology curriculum.

These initiatives must be regularly monitored by a team of experts comprising veterans in the field of academics, clinicians and administrators to peruse varied parameters which include applicability, editing the training material as per need, training effectiveness and pre and post evaluation of such trainings.

More and more career counselling centres must be opened at the national level to motivate and guide students to opt for healthcare specially the allied healthcare services as a promising career option.

Today, the well-off crowd of students can afford to avail coaching to prepare for med-

ical entrance examination but the same is not true for the not so fortunate ones.

Therefore students are forced to opt for allied health services from sub-standard and unrecognised institutes and eventually to turn out into unqualified professionals. After they pass out, either they struggle for jobs or somehow enter into sub-standard hospitals and nursing homes thereby producing or adding errors in clinical outcomes.

This in turn ultimately leaves no choice for ailing patients for the correct treatment which is their basic right. As on date, there is no data with the competent authorities on the number of medical errors arising due to involvement of unqualified and untrained medical staff in hospitals.

No doubt the Indian healthcare industry is growing at a faster pace than the last decade, however, it is also important to understand that the workforce requirement is mammoth. Also, no hospital set-up usually entertains freshers and requires experienced staff with at least a couple of years of hands-on experience. This makes the job of a hospital human resource manager all the more challenging. This situation though tends to be more favourable for candidates considering the demand and supply gap, but not suitable in the larger interest of the industry because ultimately it is the patient who has to pay the price, be it visible or invisible.

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

TATA INSTITUTE OF SOCIAL SCIENCES V.N. Purav Marg, Deonar, Mumbai 400088

School of Health Systems Studies Admission Open to Executive Post Graduate Diploma in Hospital Administration (EPGDHA) The School of Health Systems Studies (SHSS) of Tata Institute of Social Sciences in Mumbai, pioneers of Hospital Admnistration education in the country, invites application for their prestigious EPGDHA programme. It is a 12-month (two semesters), dual mode programme consisting of 18 days of class room lectures and five & a half month field and case study work in each semester.

The programme is intended to enhance the knowlege and skills of working personnel in the hospital.

Eligibility: Graduates in any discipline with a minimum of 2 years of experience and currently working in hospital. Candidates sponsored by hospitals will be given due preference. Candidates working in any part of the world can join the programme, without leaving their job.

Total Seats: 50 only.

Application form and admission: Candidates are required to apply online through the E-application process only, website: www.tiss.edu. Candidate having difficulty in applying online or where there is no internet facility may contact below numbers.

The application fees is Rs1030/- for online transfer. Application fee through bank challan is Rs. 1000 + bank charges. Please refer application form for payment details. The last date of receiving application is MAY 19, 2017. Admission will be based on the interview at TISS, Mumbai.

Programme Fee: The total fee for the programme is Rs. 1,20,000/- (One Lakh Twenty Thousands only), payable in two installments. The fee include tuition fee, learning resources, library and computer services.

CONTACT Telephone: 022-2552 5527/ 5523 / 5525 or E-mail: epgdha@tiss.edu www.admissions.tiss.edu