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CONTENTS MARKET Vol 11. No 7, July, 2017
Chairman of the Board Viveck Goenka
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SECOND EDITION OF HEALTHCARE SENATE TO BE HELD IN HYDERABAD
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JP NADDA LAUNCHES ‘SKILL FOR LIFE, SAVE A LIFE’ INITIATIVE
Sr Vice President-BPD Neil Viegas Editor Viveka Roychowdhury* Chief of Product Harit Mohanty
POLICY WATCH
BUREAUS Mumbai Usha Sharma, Raelene Kambli, Lakshmipriya Nair, Sanjiv Das, Mansha Gagneja Swati Rana Delhi Prathiba Raju
How PSUs are building competence in healthcare facilities| P-18
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
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SIDDHARTH NATH SINGH HEALTH MINISTER, UTTAR PRADESH
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BANKING ON HUMAN MILK
INTERVIEWS P12: ANUPAM
P29: NARESH JAIN
CHAKRABARTY
CEO, Ziqitza Healthcare
MD, Lindstrom India
P14: SURESH KUMAR
P30: HARALD NUSSER
Senior VP, Product Services, TÜV SÜD South Asia
Head, Novartis Social Business
P22: RP KHANDELWAL
P32: DR SANJIV AGARWAL
CMD, HLL Lifecare
MD and Founder, Diabetacare
P24: GYANESH PANDEY
P35: MADHU ARAVIND
CMD, HSCC
CEO, Searchlight Health
P28: TENZIN THARGAY Co-founder, LetsMD
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
The PSU play in healthcare
T
he days of public sector units (PSUs) in India are clearly numbered. Once hailed as navratnas, some of these jewels in the crown are today facing headwinds. Seven PSUs are earmarked for disinvestment in this financial year: Indian Oil Corporation (IOC), Steel Authority of India (SAIL), National Thermal Power Corporation (NTPC), Rural Electrification Corporation (REC), Power Finance Corporation, Neyvelli Lignite Corporation (NLC) and National Hydroelectric Power Company (NHPC). Public sector banks were first on the list and now it is national carrier Air India’s turn. Once considered upstarts, Indigo and Spice Jet are looking at the possibility of acquiring Air India. But some PSUs are here to stay, not just because they are being run well enough to make decent profits. Majority control of PSUs in strategic and sectors like public transport (Railways), those linked to the nation's fuel security (ONGC, GAIL), financial security (SBI), power (NTPC) etc., will remain with the government. Which means that PSUs as a concept are here to stay but they will have to up their game as these disinvestments are a sign that the government will not bail them out for lax financial management as in the past. A job in a PSU is still a much sought after option, as it comes with many benefits, like accommodation and medical coverage. With salaries not keeping pace with the cost of healthcare, it is no wonder that reliable and quality healthcare facilities for the family and post retirement, is a strong pull factor. With huge employee bases, some of these disinvestments might face trouble from employee unions, who fear that they will lose out on key benefits. Take the case of the Indian Railways. According to www.indianrailways.gov.in, there are 125 railway hospitals, with 13963 beds and around 133 private recognised hospitals. To put this into perspective, Apollo Hospitals Enterprise Limited (AHEL) had a bed count of 9,554 as per their FY2016 annual report, with plans to add another 1,045 beds in the next three years. With a bulging pension and consequently medical expense spend, there is no doubt that the Railways is a key provider of healthcare services to a sizable section of India. Healthcare facilities run by all PSUs are open to the general
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Almost all PSUs will scrutinise their health spends to ensure that the funds get maximum spread
public, at slightly higher fees than their own employees. As the cover story in the July issue of Express Healthcare points out, PSUs are more crucial contributors to the country’s healthcare indicators, with a better reach than the private sector in some cases. (See pages 18-21, Healthcare PSUs: Energising change). There are signs that PSUs are taking a closer look at their employee benefit policies. The Railways is the largest government employer with over 13.35 lakh employees and correspondingly has the highest number of pensioners. Last year, the authorities got a rude shock when they realised that among PSUs, the Railways had the largest increase in pensioners in the 80-100 years age group. Numbering 2.86 lakh pensioners, the 80-100 age group formed 20 per cent of the its total pensioner population of 13,75,483 and drew a combined pension of at least ` 8,000 crore. (http://indianexpress.com/article/india/india-news-india/2-8-lakh-of-its-pensioners-above80-yrs-railways-want-to-run-a-check/) The Railways immediately embarked on a house-to-house drive to verify signatures of pensioners in this age group, obviously suspecting that many of these could be fake. The obligation to subsidise the healthcare of an increasing number of aging pensioners, as well as current employees and their dependents, will definitely impact the railway's health budgets. Almost all PSUs will scrutinise their health spends to ensure that the funds get maximum spread. Part of this employee health spend is at empanelled private sector facilities, given that PSU health facilities pass on the more complicated cases to multi-speciality hospitals. These empanelled hospitals too could see increased critical scrutiny by PSU benefits committees as they try to link health outcomes with funds. PSUs would find themselves backed into a corner. Employees will demand better care, while PSU managements will be compelled to look for ways to cut cost and squeeze out more productivity and efficiencies. This could lead to many flashpoints in the near future. As some of PSU disinvestments come through, it will be interesting to see how the restructured managements manage to maintain the same commitment to healthcare and other employee benefits. VIVEKA ROYCHOWDHURY Editor viveka.r@expressindia.com
LETTERS QUOTE
JUNE 2017
Skilling the youth enhances employment opportunities and skilled India will help the nation reap rich dividends
JP Nadda Union Minister of Health and Family Welfare during the launch of ‘Skill for Life, Save a Life’initiative to promote skill development in the health sector Check out the online version of our magazine at
We are poised to enhance Universal Health Coverage in the country and are conscious of quality issues. Several efforts are underway through NHM to improve affordability, quality and access to healthcare services
CK Mishra Health Secreatry, while inaugurating ‘Vatsalya – Maatri Amrit Kosh’, a National Human Milk Bank and Lactation Counselling Centre in New Delhi
www.expresshealthcare.in
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Mobile: 91-9810843239 Fax: 0120-4367933 Email id: gaurav.sobti@expressindia.com CHENNAI Mathen Mathew The Indian Express (P) Ltd. Business Publication Division 8th Floor, East Wing, Sreyas Chamiers Towers New No 37/26 (Old No.23 & 24/26) Chamiers Road, Teynampet Chennai - 600 018 Mobile: +91 9840826366 Email id: mathen.mathew@expressindia.com BENGALURU Mathen Mathew The Indian Express (P) Ltd. Business Publication Division 502, 5th Floor, Devatha Plaza,
Residency road, Bangalore- 560025 Board line: 080- 49681100 Fax: 080- 22231925 Mobile: +91 9840826366 Email id: mathen.mathew@expressindia.com HYDERABAD E Mujahid The Indian Express (P) Ltd. Business Publication Division 6-3-885/7/B, Ground Floor, VV Mansion, Somaji Guda, Hyderabad – 500 082 Board line- 040- 66631457/ 23418673 Mobile: +91 9849039936 Fax: 040 23418675 Email Id: e.mujahid@expressindia.com KOLKATA Ajanta Sengupta
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MARKET PRE EVENTS
Second edition of Healthcare Senate to be held in Hyderabad The theme for the second edition is ‘Building a future-ready healthcare sector for India’
A
fter the success of the inaugural edition of Healthcare Senate last year, Express Healthcare is gearing to host the second edition of the event. This time, the theme is ‘Building a future-ready healthcare sector for India.’ The summit will be held at Novotel Airport, Hyderabad, from September 7-9, 2017. Thought leaders from the healthcare industry will congregate to exchange insights, share innovative ideas and build healthy connections. The event will address pivotal topics through panel discussions: They would include: ◗ Overcoming obstacles in business expansion: In this
session, the panel will discuss strategies, infrastructure required and resource development needed for expansion of businesses. ◗ Healthcare policies: Are they making or breaking the sector?: Association heads of AIMED, NATHEALTH, NABH, AHPI, NPPA and government officials will discuss the impact of pricing policies, quality codes etc., on the sector. The panel will also deliberate on the need for an Affordability Act in India. ◗ Fighting the antibiotic apocalypse: Infection control experts, hospital administrators, pharma companies, NABH representatives will
discuss ways to control the increasing burden of antibiotic resistance ◗ Ensuring cost efficiencies within capital intensive department: Radiology department heads of hospitals, imaging diagnostic promoters, Cath lab heads, OT heads and hospital CFOs will discuss how to reduce operating costs of these capital intensive departments to make the business profitable. ◗ People first: Hospital CEOs, promoters, nursing heads, HR heads, management consultants will discuss on building talent and capabilities for the future. Revenue cycle transfor-
mation- A must for healthcare organisations: Hospital CAs, financial experts, healthcare CFOs, COOs or CEOs and PE investors will discuss on ways and means to increase their net revenue, accelerate cash flow, and reduce costs by addressing people, process, and technology components within their hospitals.
The other topics which would be addressed at the event will be: ◗ Building an effective supply chain inventory management system ◗ Developing a physician leadership programme within hospitals
◗ Effective brand building for business success ◗ Understanding medical laws: a must for healthcare providers ◗ Medical tourism: An ocean of opportunities for India ◗ Evolving role of hospital pharmacies in India To register, click : http://healthcaresenate. financialexpress.com/ registeration/ or Contact Vinita Hassija Mob: 9820590053 E-mail: vinitahassija@gmail.com
National Health Conclave to holistically address issues related to health and NCD Dr Alexander Thomas, Executive Director - Association of Health Providers - India (AHPI) and Organising Chairman, National Health Conclave, gives an insight about the need of a multipronged approach to prevent NCDs, including early screening, diagnosis, management, public awareness and legislation THE NATIONAL Family Health Survey-4 (NFHS-4) assesses the health status of our nation through an intense process of data collection done throughout the country on key parameters of health. Historically, NFHS has focussed on maternal and child health, nutritional markers of health, family planning and communicable disease risk factors. In addition to the above, the latest survey has also looked at key metabolic indicators like body mass index (BMI), random blood glucose (RBG), and blood pressure in adults, which are indirectly indicative of the prevalence of Non-Communi-
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cable Diseases (NCDs) in India. The prevalence of obesity varies from state to state, with 31 per cent of women and 29 per cent of men in urban areas considered obese. The high rates of obesity in general, and in some states/Union Territories in particular, raise concerns about the future metabolic health of the people. It has been scientifically proven that obesity is the forerunner of metabolic dysfunction and predisposes one to illnesses such as diabetes and hypertension. According to the survey data, 6.7 per cent of the women and 10.4 per cent of the men in India have hypertension. Sim-
ilarly, 5.8 per cent of the women and eight per cent of the men in India have a high blood sugar level. While not all states have reported NFHS-4 data, the available statistics need to be analysed carefully as data trends indicate that this is just the tip of the iceberg with regard to NCDs. Although urban areas currently show more morbidity than rural areas, consumption patterns and lifestyle changes taking place in rural areas indicate a preference of unhealthy habits. This is likely to result in increased morbidity over a period of time. Before the situa-
tion deteriorates further, we need a multi-pronged approach to prevent NCDs, including early screening, diagnosis, management, public awareness, and legislation. An effective and sustainable strategy can be developed only if all key stakeholders in the health sector work together to address this complicated challenge. The National Health Conclave 2017 being organised in New Delhi from August 10-11, 2017 is, therefore, a timely and important initiative. The conclave will be the first step in a multi-collaborative approach as a national level think-tank to
holistically address issues related to health, and more specifically, NCDs. Bringing together all stakeholders with experience and expertise in various levels of healthcare, it provides a unique platform through which policies and strategies can be formulated. The combination of government, academia, industry, community and international agencies that are part of the conclave will provide muchneeded direction to address the growing burden of NCDs in our country. Express Healthcare is the National Media Partner for the Conclave.
MARKET I N T E R V I E W
‘Lindstrom to expand its footprints in India’ Visakhapatnam.
Anupam Chakrabarty, MD, Lindstrom India, divulges that his company is now looking for new opportunities in tier I and tier II cities of India to expand its presence in healthcare segments like smaller clinics and diagnostic centres, in an interview with Prathiba Raju Hygiene of the work environment and work wear is extremely important in the healthcare and pharma sectors. How does Lindstrom help ensure utmost hygiene? As a business house, Lindstrom is completing 170 years of its existence next year. As for our operations in India, we started it in 2007 and our first unit was in Chennai. In India, we concentrate on two segments: one is pharma and other one is the food sector. We have our presence in 11 states which includes pharma industrial hubs of India like Baddi, Hyderabad, Ahmedabad, Pune, Bengaluru, Mumbai and Visakhapatanam. We have our facility in Assam as many pharma and FMCG companies are investing in the state. This is one segment where the hygiene levels are very critical and the standards of work wear are clearly compiled; there are lot of standards that exist. There are USFDA, MHRA audits so all the clients are subjected to some kind of external
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This is our tenth year of existence in India currently we have about 1.5 million garments in circulation and we plan to double it by 2020
audits to some sort of external audits. So, a work wear company like Lindstrom has a huge role to play, 35 per cent of our business today is from the pharma sector. As far as health is concerned, it has two parts, one is the hospitals and the other is healthcare centres like clinics, diagnostic centres. As of now, our activities in the healthcare sector is focused on clinics and diagnostics, we are not formally getting down to the larger hospital chains as it needs a lot of compliance activities. How important is the pharma sector for you? We work with over 300 pharma companies in India. Earlier, many pharma companies used to buy the garments and have their own work wear and laundry, usually the APIs outsourced work wear. But now the scenario is changing, as most of the Indian pharma companies face hygiene and cleanliness issues. What looks clean might not be really clean.
The work wear garments need to be not just clean but bacteria-free. If not, they might end up contaminating the product. So, we had to instill the concept of bacteria-free garments to the quality and production team of pharma companies. Explain to them that a person who is wearing the garment might also be contaminated by the clothes he/she is wearing. For example; in the oncology facility, the fabric selection itself is very critical and they should be washed separately, as they might cross contaminate, so a separate infrastructure is needed. Many such intricacies were missed by the pharma companies and Lindstrom India fills this gap. We study the end application of the customer, and the working environment. Based on that, we recommend the product, servicing and testing of the product. Indian pharma sector is in an upgradation phase and it is one sector where the standards are continuously rising and the companies are
asking for tracking of garments, clean room requirements. There are few pharma companies who are still in the traditional mode and do not outsource work wear. Can you brief us about your expansion plans? It is the tenth year of our existence in India. We have established 11 business units pan-India and we have ended up putting one or two units every year. We, as a global organisation, has set a vision for a five year period. As of now we are a 323 million euro company and trying to scale it to 500 million euros by 2020. In India, currently we have about 1.5 million garments in circulation and we want to double it by the year 2020. If we continue at the current pace, we should achieve 18 to 20 units by 2020. Till the time we achieve the critical mass of 100,000 garments in circulation in a particular location we do not establish a centre. Recently we started our 11th facility in
What are the challenges you face among corporate hospitals clientele? Healthcare is becoming big and has its own set of challenges. One of them is the high attrition rates and therefore there is work wear management. For example; if a corporate hospital appoints 1000 nurses you see atleast 200 nurses leaving every month. So, it requires that much additional management of work wear and it is not a small task, back-end management of work wear is quite critical. So, currently we are concentrating more on the smaller health clinics, diagnostic centres as they don’t have a system in place for work wear management. We are trying to create a brand image for them and put in some basic hygiene practice. We are looking for new opportunities in tier I and tier II cities of India. Is textile waste a challenge, when it comes to the healthcare and pharma sector? During textile washing, especially in the pharma and healthcare segments, a lot of effluents are generated and it needs to be treated or disposed as per the standards prescribed. In Lindstrom, we have our own standards which are far higher than what the local standards indicate. It is one area where we work on significantly and we come out with a sustainability report every year. It specifies about the amount of water we use and the carbon footprints. We challenge ourselves every year, try to use less power and water consumption. We incinerate the waste produced in the pharma sector. But, in the food segment we try to recycle the waste. For example; fabric waste is recycled and made into sanitary napkins and supplied in rural areas via NGOs. prathiba.raju@expressindia.com
EVENT BRIEF AUGUST - SEPTEMBER 2017 26
GIBS 2017
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GIBS 2017 Date: August 26-27, 2017 Venue: Hotel Orchid, Vile Parle, Mumbai Summary: Global Interstitial Cystitis Bladder Pain Society will organise second Global Interstitial Cystitis Bladder Pain Syndrome conference (GIBS 2017). The two-day event will help gain new insights into IC/BPS where national and international faculties will take part in casebased panel discussions. Contact details Premsaikrishna Warrier Swati Spentose 114, Marine Chambers Mumbai-400020
HEALTHCARE SENATE 2017 Date: September 7-9, 2017 Venue: Novotel Airport, Hyderabad, Summary: After the success of the inaugural edition of Healthcare Senate last year, Express Healthcare is gearing to host the second edition of the event. This time, the theme is ‘Building a futureready healthcare sector for India.’ Thought leaders from the healthcare industry will congregate to exchange insights, share innovative ideas and build healthy connections. They would include: ◗ Overcoming obstacles in business expansion: In this session, the panel will discuss strategies, infrastructure required and resource development needed for expansion of businesses. ◗ Healthcare policies: Are they making or breaking the sector?:Association heads of AIMED, NATHEALTH, NABH, AHPI, NPPA and government officials will discuss the impact of pricing policies, quality codes etc., on the sector. The panel will also deliberate on the need for an Affordability Act in India. ◗ Fighting the antibiotic apocalypse: Infection control experts, hospital administrators, pharma companies,
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HEALTHCARE SENATE 2017
NABH representatives will discuss ways to control the increasing burden of antibiotic resistance ◗ Ensuring cost efficiencies
within capital intensive department: Radiology department heads of hospitals, imaging diagnostic promoters, Cath lab heads, OT heads and hospital
CFOs will discuss how to reduce operating costs of these capital intensive departments to make the business profitable.
Contact details Vinita Hassija Mob: 9820590053 E-mail: vinitahassija@gmail.com
MARKET I N T E R V I E W
‘New Medical Devices rules would usher in rejuvenated regulated atmosphere’ Suresh Kumar, Senior VP, Product Services TÜV SÜD South Asia, in an interaction with Viveka Roychowdhury, opines that the medical devices industry will receive an exponential boost once regulations are in place TÜV SÜD was the first independent certification firm in India to receive an accreditation from National Accreditation Board for Certifying Bodies (NABCB) to grant certifications for ISO 13485 & ICMED Schemes. What is the certification process? Does it involve site audits, etc.? What are the parameters required for such certifications? How many such certifications have been granted so far? And what are the costs involved for manufacturers to obtain, maintain and renew such certifications? Medical device manufacturers can apply to TÜV SÜD for ISO 13485 and ICMED schemes to obtain certifications that indicate their products comply with regulations for domestic use and exports. The initial certification process entails onsite documentation and compliance audits. Once the organisation meets the quality requirements, it is awarded a certification for three years. The validity of the certification is subject to the successful completion of announced surveillance audits in the following two years. In ICMED schemes, surveillance audits are conducted spontaneously. Since this is a comparatively new accreditation, we have a considerable number of certifications that are in the pipeline for final closure. The costs for obtaining these certifications are commensurate with global standards and consists of elements such as annual certificate license and certification body review services.
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TÜV SÜD is also part of the Medical Device Single Audit Programme (MDSAP), which is aimed to help manufacturers get their devices into multiple global markets through a single audit. MDSAP was slated for official implementation from January 2017. What is the update on this? What is the response? The pilot phase of the MDSAP programme concluded on December 31, 2016 and became operational on January 1, 2017. Medical devices manufacturers face two significant challenges — increased product development costs and time to market. They need to apply for testing and certification with different certification bodies to gain access to individual export markets. MDSAP allows authorised auditing organisations to conduct a single audit of a manufacturer’s quality management systems that will satisfy some requirements of the regulatory authorities of each participating country. It saves time and money as business can gain access to multiple markets with a single audit programme. This single audit programme helps business save money, minimises administrative overheads and reduces the number of annual audits that help businesses enter markets faster. TÜV SÜD works closely with clients that are a part of the MDSAP programme. It can support any medical device manufacturer regardless of their current certification body. Being one of the largest notified bodies, TÜV SÜD provides expert onsite technical file review gives access to information that
helps the manufacturer understand any noncompliance issues.
Stringent quality control and certification measures at a domestic level can help drive down costs and increase quality at the same time
Consumer perception is that low cost is linked to low quality. How can indigenous manufacturers of life saving products like medicines and medical devices counter this perception? Contrary to popular perception, the cost of any medical device is not a function of its quality. Traditionally, imported devices have been costly because of the multiple layers of taxation. Stringent quality control and certification measures at a domestic level can help drive down costs and increase quality at the same time. Indigenous manufacturers can contribute by self–regulating the quality of products manufactured by them. This in addition to a policy and regulatory collaboration can help counter the perception of cost being a function of quality for medical devices. The ISO 13485 and ICMED certifications awarded by TÜV SÜD specifies requirements for a quality management system that can benefit an organisation right from design to practical usage of medical devices and related services. By getting their facilities certified by a reputed notified body like TÜV SÜD, organisations have the potential to contribute toward changing the perception of consumers and ensure quality products. What is your take on the recently notified Medical Devices Rules 2017, the Indian government's first
MARKET move to regulate this sector? Are these Rules in harmony with global regulations? What are the points of deviation and these justified? The new rules notified under Medical Devices Rules 2017 seek to remove regulatory bottlenecks to Make in India, facilitate ease of doing business and ensure availability of better medical devices. They have been framed in conformity with Global Harmonisation Task Force (GHTF) framework to adapt to best international practices. The new Medical Device rules would usher in a rejuvenated regulated atmosphere. Yes, the new rules are in sync with International Medical Device Regulators Forum (IMDRF) and will benefit the industry on a large scale as the organisations will now compete at a global level. In Budget 2017, the government proposed to move the medical devices segment out of the pharmaceutical sector to attract foreign investments. Do you see any positive movement as yet on this front? The announcement made in this fiscal’s budget has directionally propelled the Indian medical industry to invest in indigenous manufacturing. Currently, 75 per cent of the total demand for medical devices is met with imports and nearly 30 per cent of it is imported from the US alone. We are importing from a country that is one of the global champions in medical devices innovation and due to which there is a disparity between the design of certain technologies and the conditions of healthcare infrastructure in India. Also, regulatory standards of medical devices are not upgraded periodically causing ambiguity in standardisation of medical devices. Globally, the medical devices industry is separate from pharma sector and governed by an independent set of legislations and regulatory framework. The Indian pharma industry has already earned worldwide respect and it is
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time for India’s medical devices industry to follow the suit. The announcement has given a tremendous boost to indigenous manufacturing to achieve global manufacturing competitiveness and make devices more affordable. Post the announcement, the
government has proposed to set up a separate ministry for Indian medical devices. It is encouraging to see the government’s intention to transform the industry with the right amount of policy push and similar changes will take its time to streamline the entire infrastructure.
While some policy measures seem to favour the industry, others are clearly with the end user in mind, like the recent crackdown on prices of heart stents. NPPA is sure to follow with more price constraints on other high-end medical device categories like orthopaedic
implants. Will these moves discourage further investment of both global and local players into the medical devices sector in India? We support the government’s decision because the aim of this policy measure resonates with our vision, to safeguard
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MARKET patients’ interest and their safety. We believe, it has the potential to encourage global and local players as the decision to cap prices on medical devices will rid the industry of pricing ambiguity that will boost domestic manufacturing and uphold trust and safety in minds of the end-consumers. Domestic manufacturers may still be able to make medical devices at prices lower than global competitors but is this a sustainable business model? With increasing price constraints, and decreasing margins, will regulatory requirements like accreditation, certification, etc. be an additional burden on local manufacturers? The regulatory framework for the Indian medical devices industry has been rudimentary with a duty structure that is not highly favourable for manufacturers. However, there is an opportunity for businesses to understand the dynamics of the market and launch devices and device-based therapy models that are a breakthrough in innovation. The Make in India initiative has accelerated foreign investment and encouraged global organisations to set up manufacturing in India. This is an opportunity for such organisations to partner with domestic com-
panies for an efficient growth strategy. Partnering with certifying bodies such as TÜV SÜD that conduct quality testing audits of manufacturing units as well as the devices will instill an increased level of trust among other manufacturing companies vying for market entry. This accreditation acts like an enabler for domestic manufacturers and helps them embrace global standards of safety and quality. Our dependence on imports has shadowed the innovative capabilities of domestic manufacturers. To empower them, tax incentives could be offered to promote manufacturing. As local manufacturing becomes the norm, it is likely that an overall tone of affordability would be set in the industry. We are witnessing a growing interest among entrepreneurs to revolutionise the Indian medical device industry by developing products that are low-priced and high-quality, and such initiatives should get an appropriate policy push. Industry reports suggest that the Indian medical devices market is at $3.8 billion in 2014 and is expected to grow to $8.6 billion by 2020 but India still imports 70 per cent of medical devices. What more should the government, both
The government should further incentivise the ‘Make in India’ campaign so that more domestic companies can be encouraged to manufacture devices in compliance with global standards at the centre and state level, do to rectify this situation to promote and incentivise Make in India? The government’s recent effort to move medical devices out of the pharma sector is a welcome move for the domestic manufacturers. We are certain that industry will receive an exponential boost once the regulations are in place. To ensure a sustained growth of the Indian medical devices market, the government should further incentivise the ‘Make in India’ campaign so that more domestic companies can be encouraged to manufacture devices in compliance with global standards. How do medical devices exporters juggle the varying regulatory requirements of different countries? At present, they may approach each market separately. With MDSAP by
TÜV SÜD, this will help and ease their regulatory burden. MDSAP is a single audit programme that satisfies some requirements of the regulatory authorities of each participating country. Manufacturers across the globe can participate in MDSAP. The five participating regulators are in these countries — the US, Canada, Brazil, Australia and Japan; and the medical product must fall under the scope of at least one participating regulatory authority and be subject to their quality management system requirements. For maximum accountability, TÜV SÜD assigns one lead auditor who is responsible for tracking certifications, managing change notices, and delivering a rapid response to the queries. An inherent part of our services is to keep our
customers and partners updated with the dynamic landscape. We have a proprietary E-ssentials newsletter that helps manufacturers stay updated with the latest developments of the MDSAP programme. At an operational level, have local medical devices manufacturing facilities met the scrutiny of global regulators? Are local medical device companies training their staff to handle facility inspections and audits? Some local medical devices manufacturing facilities have been successful in meeting the scrutiny of global regulators, but this is not the case across the board. Staff training for handing facility inspections and audits are largely at the discretion of the company and there is immense opportunity to improve. At TÜV SÜD, we also provide separate training sessions with an aim to help the manufacturers understand safety and quality guidelines as well as the related certification technicalities. These training modules help manufacturers improve the ecosystem of quality awareness among their employees, thereby effecting world class manufacturing of medical devices. viveka.r@expressindia.com
NEWS
JP Nadda launches ‘Skill for Life, Save a Life’initiative The initiative aims to upscale the quantity and quality of trained professionals in the healthcare system JP NADDA, Union Minister for Health and Family Welfare, launched the ‘Skill for Life, Save a Life’ initiative at a recently held function in New Delhi. Speaking on the occasion, Nadda said that India enjoys a demographic dividend as more than 65 per cent youth are below the age of 35 years and the government is determined to seize this opportunity by providing adequate skills
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and employability to the youth for a strong foundation for continued and sustainable growth. ‘Skills for Life, Save a Life’ Initiative’ aims to upscale the quantity and quality of trained professionals in the healthcare system. Under this initiative, various courses are planned to be initiated targeting specific competencies for healthcare professionals as well as for general public.
Rajiv Pratap Rudy, Minister of State for Skill Development and Entrepreneurship, Faggan Singh Kulaste, Minister of State for Health & Family Welfare, CK Mishra, Secretary (Health & Family Welfare) and Dr Henk Bekedam, WHO Representative to India were also present at the occasion. Nadda said that skilling the youth enhances the employability and skilled India will help
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The logo of ‘Skills for life, Save a life’ along with the Standardized Professional curriculum was also launched the nation reap rich dividends. “This shall reduce the gap between expectations of employment of the youth and the actual job they get, Nadda added. The health minister further pointed out that skill enhances economy of the country, too by reducing the gap between demand and supply of trained and skilled manpower in every field. The potential for skilled healthcare workers and professionals is immense in the country. Such courses ensure that the health sector gets the adequate skilled health workers. Nadda further informed that the curriculum has been designed by National Institute of Health and Family Welfare (NIHFW) and AIIMS, Delhi. The health minister highlighted that in India 1,324 accidents occur on roads every day and a life is lost every four minutes and measures taken in the first 10 minutes can save a life. It was thus announced that the Ministry is initiating its’ ‘Skill a Life, Save a Life’ programme by launching first responder course for professionals as well as general public, to be conducted in central and state government training institutes from the next month across the country in each district, to empower every single citizen of the country to be the first person to provide first aid and initial care in case of an emergency. Rudy said that skill development provides platform for lakhs of youth in the country to get trained for employment. The Skill Development Ministry is providing several certified courses for skilling to provide manpower for various areas of work. Kulaste stated that the
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trained and skilled personnel, through this innovative training course, will be able to help save lives in the golden hour during an emergency situation. Mishra stated that India is working towards the attainment of the global mandate of Universal Health Coverage (UHC) for providing affordable,
accountable and appropriate health care of assured quality to the fellow citizens, which is possible through substantive and strategic investment in the health workforce. Nadda also launched the logo of ‘Skills for life, Save a life’ along with the Standardized Professional curriculum for –
physiotherapy, optometry, dialysis therapy technology, medical radiology and imaging technology, radiotherapy technology, health information management, operation theatre technology and medical laboratory science and shortterm training courses with varying entry qualification in -
first responder, general duty assistant, geriatric care assistant, home health aide, phlebotomist, sanitary health inspector, dietetic aide, diabetes educator, emergency medical technician- basic and medical equipment technology assistant. EH News Bureau
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How PSUs are building competence in healthcare facilities BY PRATHIBA RAJU
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F
NUMBER OF COMPANIES FOR WHICH CSR DATA IS AVAILABLE
2014-15
Source: Factly
or years together, the 300-plus PSU hospitals under the central and state governments have upheld a culture of comprehensive healthcare services to their employees and dependants. Most PSU hospitals run by Miniratna, Maharatna and Navaratna companies contribute immensely towards patient services. Right from ensuring hygiene and transparency, and averting unnecessary queues, PSU-run hospitals have been synonymous to better patient outcomes. PSU organisations established with the objective of profit making in certain specified government sectors have been contributing immensely to healthcare via PSU hospitals by not only catering to the healthcare needs of their employees, contract workers and their families, but also offering services to people from in and around the cities, towns, village they operate. They are also known for effectively handle emergency cases like accident victims and heart patients. As per the latest data compiled by the government, the total corporate social responsibility (CSR) spending has increased by around 11.6 per cent in 2015-16 compared to 2014-15. The CSR spending by PSUs has substantially increased in 2015-16 as compared to 2014-15. From `2,497 crore in 2014-15, the spending has gone up to `3,360 crore in 2015-16, an increase of 35 per cent. This follows adverse comments by the parliamentary standing committee on the CSR spending of PSUs. On the other hand, the spending by private companies has increased only marginally from `6306 crore in 2014-15 to `6462 crore in 2015-16. “PSU hospitals get full funding from the PSUs and the grant they receive depends on the profit and other policy decisions. In some sense the PSU hospitals are part of their CSR activities,” informs Professor M Mariappan, Tata Institute of Social Sciences (TISS). Further, these hospitals are mainly focussed on their employees, so as to ensure the employee health which is directly associated with the productivity of PSU. Their overall administration, patient care and other important concerns are slightly better than the
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226
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172
PSUs
government hospitals. The government hospitals basically run as per the budget allocation of state or central governments. Usually they do not receive funds timely. As a result, the fund management or carrying out activities as per their plans may be difficult. In contrast, he points out that the private hospitals are able to serve with quality healthcare. However, they are costly for a large number of patients in the country. Unlike both a typical government and private healthcare facilities, PSU hospitals have some attachment towards their patients, because most of the patients are their employees. Employees are regular and stable workers. The relationship between the staff (patients) and doctors and nurses are relatively long lasting. Since the hospital is closely connected with the PSU, there are possibilities to provide better organised services. Among the various activities for which CSR funds are allocated, education, health and WASH (Water,
Private Companies
Sanitation & Hygiene) are the sectors in which most funds are spent. The healthcare and WASH sector has seen almost six per cent increase in the CSR spending in 2015-16. In healthcare, most PSUs concentrate on child mortality and maternal health, while MCA had data of 226 PSUs in 2014-15. It had the data of only 172 PSUs till date for 2015-16. The hospital's cultural climate is critical to the success of quality improvement programme, PSU-run hospitals have exceptional work culture, informs Shankar Narang, COO, Paras Hospitals, a multi-super specialty hospital, which has more than 35 PSUs empanelled to it. “PSUs have the power to lead and invent exceptional processes to ensure that their employees are provided seamless healthcare services. The work culture in a PSU hospital is definitely good. They have exceptional numbers for primary care. They have a rich team of general physicians and doctors providing basic healthcare services,” Narang added.
Providing comprehensive care Apart from providing emergency services and routine medical care for employees, PSU hospitals have dispensaries in their residential colonies, family welfare centres with a team of general practitioners and specialists. Acknowledging the fact that ensuring good health of employees, their families and people residing in the surrounding areas of its plants and units is not just a matter of corporate responsibility, but a pre-requisite for sustainable all-round development, an official from Steel Authority India Limited (SAIL) said, “Over the years, SAIL has established 54 primary health centres (PHCs), 12 reproductive and child health (RCH) centres, 17 hospitals and seven super-speciality hospitals to provide modern healthcare to more than 30.60 million people. The hospitals have a total strength of around 4043 beds for the benefit of its employees, their
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cover ) dependants and the peripheral population and are managed by around 4000 trained medical staff. SAIL hospitals also implement the government’s RCH programme across all its plants and units.” He also added that villagers with major ailments are referred by the health centres to the main plant or government hospitals for treatment, while minor operations are carried out in the centres. Highlighting the health initiatives carried out by National Thermal Power Corporation (NTPC), the largest power utility maharatna company, an official said that they are specifically working on tuberculosis and NTPC has partnered with the Government of India on Revised National Tuberculosis Control Programme (RNTCP). “Modern anti-TB treatment can virtually cure all patients, provided the treatment is taken for the prescribed duration, without interruption. Because of the long duration of treatment, patients who begin to feel better soon after the treatment starts, discontinue it, due to problems such as poverty and unemployment,resulting in fatality or development of multi-drug-resistant TB (MDR-TB). Thus, NTPC wants to help patients diagnosed with TB and we want them to be treated effectively till cure, by ensuring availability of the full course of drugs and a system for monitoring patient compliance to the treatment. Under CSR, NTPC provides a room for the consulting doctors, a small laboratory with microscope. An ambulance with paramedical staff, driver and PA system is provided which moves around the villages: creating awareness about TB, collecting and checking sputum samples, registering positive cases, collecting medicines from government centres and administering medicine to the TB patient under direct observation for the required duration. So every TB patient residing in the vicinity of 25-30 km of a station is brought under the TB Control Program. We ensure full course of drugs and patient compliance to treatment and we operate Directly Observable Treatment cum Designated Microscopy Centres (DOT cum DMC),” the NTPC official informed. Apart from the TB programme, NTPC also provides need-based infrastructural support for healthcare like construction of PHCs, additional wards, ICUs etc. NTPC is also supporting the development of King George Hospital, Visakhapatnam. Mobile Medical Units (MMU) is one of the healthcare initiatives which is carried out by most PSUs.The Indian Oil Board has accorded approval for Indian Oil Aarogyam scheme which will be launched in three Indian Oil refineries i.e. Mathura, Paradip and Bongaigaon on a pilot basis. “Forty eight villages located within a 50-km radius of the refineries are being identified based on approved criteria. Four MMUs with medical staff will visit these specified villages and treat around 2080 patients per month, i.e. 24960 patients in a year. One refinery unit with four MMUs will treat approximately 1 lakh patients per year. Tentative date of launch is around August 2017,” said Kali Krishna M, Chief General Manager, Corporate Communication, Indian Oil Corporation. Many PSU hospitals under the CSR initiative are trying to provide organised, referral-based system for
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CSR INITIATIVES INDIAN OIL CORPORATION - REGULAR CSR ACTIVITIES UNDER HEALTHCARE BY VARIOUS REFINERY UNITS ◗ Health Camp at Village Baad, Mathura, for ` 65,000 ◗ Medical Check-up camp for contract workers/villagers at Baad for `28000 ◗ Hosting of eye-screening camp, sponsored cataract surgeries and prescription spectacles through Sri Sankaradeva Nethralaya for beneficiaries from Chandrapur locality by Guwahati Refinery for `1.40 lakh. ◗ Reimbursement to Dr B Borooah Cancer Institute. for treatment of BPL category cancer patients from nearby areas by Guwahati Refinery for ` 4 lakh ◗ Organising two healthcare camps on need basis by Guwahati Refinery for `1.35 lakh ◗ Women Health Camp(CD Hall) by Guwahati Refinery for `36000 ◗ Health Camp by Barauni Refinery for `7.37 lakh ◗ 'Women-centric health camps and nutrition by Haldia Refinery for `3.90 lakh ◗ Upgradation of primary health centre by Paradip Refinery for `9.70 lakh. Amount deposited to BDO, Erasama, Jagatsinghpur on 23.12.16 but utilisation certificate not received yet. ◗ Supply of 50 adjustable medical beds by Paradip Refinery for `7.50 lakh. ◗ Organising Health Camps on quarterly basis by Paradip Refinery for `11.83 lakh. ◗ Medicines for Thalassemia patients to Indian Red Cross Society by Gujarat Refinery for `7.48 lakh ◗ Procurement of ultra sound unit for VET at VCARE by Gujarat Refinery for ` 2.70 lakh ◗ Medical camp at surrounding villages for general public by Gujarat Refinery with an estimated cost of `3 lakh ◗ Eye camp at RHQ & CO for contract workers for `63,000
NTPC – HEALTHCARE INITIATIVES VIA CSR Stress on preventive measures and inculcate healthy lifestyles: ◗ Distribution of mosquito nets in malaria prone areas for malaria prevention ◗ Fogging, spraying, anti-larvae spray ◗ Yoga camps in schools ◗ Community / individual household toilets. ◗ Under GoI’s Swachh Bharat Abhiyan, NTPC has ensured availability of about 29,000 toilets in government schools across India. ◗ Providing safe drinking water in the villages around its stations/ projects
secondary care. NTPC, Indian Oil Corporation (IOC), Gas (India) Limited (GAIL), Oil and Natural Gas Corporation Limited (ONGC), Neyveli Lignite Corporation (NLC) and many other PSU hospitals provide quality healthcare to the people living in the surrounding villages.
Reaching out to the unreached The PSUs have taken initiatives to improve healthcare facilities in North East areas and Uttar Pradesh, as majority of the patients move out of the state for speciality treatment. “IOCL’s Assam Oil Division (AOD) hospital was established as Digboi Hospital in 1906. The hospital was declared under the CSR activity for better healthcare system, preventive and public health services were initiated. It is a modernised 200-bed hospital which caters to the population of areas in the North East. General and specialised health camps are also organised regularly by the hospital to reach out to the poor villagers nearby, who have no access to medical facilities. Last year alone, 16,423 non-employee patients were treated at the hospital. The services available in the hospital are free of cost for the IOC employees and their dependants comprising parents, spouse and two children, who are recognised as Entitled Patient (EP). IOC also renders services for the community at large scale with nominal charges, recognised as Non Entitled Patient (NEP),” Krishna says. According to the Krishna, the same hospital runs Sarve Santu Niramaya (SSN), a CSR project since 2012 to provide free health consultation and medicines to both human and livestock population of Digboi and nearby areas. The Chikitsa Seva Kendra, BGR, Assam was set up in 1996 at Kukurmari (Bongaigaon) with paramedical staff, OPD services and free consultation. “On an average 30-40 patients visit the centre every day. It is beneficial for marginalised people residing in the neighbouring areas. More than 35,000 locals have benefited out of this initiative,” Krishna added. Listing out the details of the IOC healthcare initiatives, the official further said, “The other well-known hospital of IOC is Swarna Jayanti Samudayik Hospital, Mathura, Uttar Pradesh. This 50-bed hospital provides medical assistance to residents near Mathura Refinery, Uttar Pradesh. Two mobile dispensaries travel to nearby villages to provide free medical care to the villagers. The hospital provides free treatment to the destitutes and offers subsidised treatment to others. During 2015-16, 52,660 patients were treated, and so far about eight lakh patients have benefited from this project.” ONGC, one of the biggest PSU spenders, has signed a Memorandum of Agreement (MoA) for setting up a multi-speciality hospitality in Assam. The PSU signed the MoA with Aurangabad-based Dr Babasaheb Ambedkar Vaidyakiya Pratisthan (BAVP) to set up the `312.34 crore hospital at Rajabari in Sibsagar district, which would be completed in three phases. An ONGC official informed that ONGC is committed to implement its CSR initiatives across the country and has given special focus on the North East by setting up its single largest project anywhere in the country. Many patients requiring secondary healthcare are
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care and are not able to know the hospitals that provide cashless facility. This limits their choice or inherently makes them totally dependent on the in-house medical team for directions. We believe that a patient from a PSU is a person who should be aware of all options and then choose as per their will and conditions. Hence to bridge the gap of creating education, Paras Hospital has started numerous patient reach campaigns such as highlighting and promoting our presence on social media channels such as Facebook and Twitter. Northern Railways was particularly benefited through this campaign and the response has been quite positive. Many PSU employees are not aware about the steps of availing medical benefits. We have formulated a standard procedure of explaining to the patient and their attendants the same. We also provide them the contact numbers and details of their medical arm that can facilitate them in the approvals and the decision making,” Narang added. At present, PSU hospitals refer patients to private sector hospitals for higher-level of treatment. The major issue likely to arise between PSU and private sector is that the private sector usually expects a profit where a PSU does not have a profit motive. The work culture to a large extent is process-oriented. Private hospitals have the limitation of providing services which could be loss making if they are long-term in nature. It must be a two-way exchange of information and returning patients to those who referred them for follow up care. Though PSUs have the power to lead and invent exceptional processes to ensure that their employees are provided seamless healthcare services, it is essential that they come together and work at a better framework that can address all their gaps.
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6462.1
Filling the gaps
5097
9822.3
Source: Factly
PERCENTAGE OF FUNDS SPENT ON VARIOUS CSR ACTIVITIES
CSR EXPENDITURE DURING 2015-16 Financial Year 2015-16 Sl. No.
Company Type
1.
PSUs
2
Private Sector Companies
No.of companies for which data has been compiled
Total
Actual CRS expenditure (in Rs.Crore)
Source: Factly
referred to these PSU hospitals. At many locations, these are the only hospitals available, providing the required secondary care to the surrounding villages.
Rapport with private hospitals PSUs are organisations that are looking for exceptional care, personalised services and attention. Just like numerous government employees, they have health coverage through various instruments to provide medical benefits. Majority of PSUs provide full coverage to their employees for treatment. They individually associate with the hospitals through an MoU and may or may not follow a set pattern of tariff. Informing that PSUs have in-built systems to ensure that the employees opt for the right doctor, hospital and specialisation, Narang of Paras Hospitals explains, “They have an in-house medical team that scans their medical issues to recommend hospitals. They also provide the patients an authorisation letter to ensure that the patients have been authorised and cleared with approvals for the treatment. This also assures the hospital that the bills shall be duly approved by the PSU and also creates a feedback and monitoring mechanism that benefits the patient. In
case of emergency conditions, the hospital and the medical arm of the PSU coordinates to ensure that the patient doesn’t suffer. Treatment is provided and letters are given later.Hospitals understand the strength of the PSUs and the employee numbers, hence service delivery, efficiency along with transparency and good follow up become pivotal along with relationships. We are the preferred providers for neurosurgery, neurology, cardiology, cardiac surgery and orthopaedics and joint replacement. At Paras Patna, we are also the preferred providers for cancer and nephrology.” He also added that Paras gives PSU employees a number of benefits like cashless facility, much discounted rates than the other general self paying patients, assistance in facilitation of medical services, free or discounted rates for emergency facility like ambulance and organising free medical check-ups and talks by seniors or HODs. However, there are a number of challenges that PSU employees face while seeking or searching for medical care. Many employees are not aware which private hospitals they are empanelled. “Numerous patients are looking for specialised
According to experts, a concerted effort by the central and the state governments is necessary so that the initiatives made by PSUs in healthcare could be channelised. They have sufficient scale and connectivity, so if one could work with them to understand their perspective and try to put a framework in place, healthcare issues could be sorted out in a more systematic and cost-effective manner. For example, two or three PSUs and private healthcare facility existing in a common area with the available resources can jointly run disease control programmes and family welfare programmes with the help of the state and central government. Thus it will help in optimum utilisation of the existing resources. “It is good to develop a partnership with all kinds of hospitals, particularly the government hospitals. It is understood that the care provisions, practices, methods and kind of patients of PSUs are much different from that of government hospitals. The objective, nature of functions, kind of patients vary between PSUs, government and private run hospitals. Further, the nature of funding makes a huge difference. In India, the healthcare sector is too diverse which caters to different kinds of population. If the three segments — PSUs, state and the central government — align together, they can transform and bring in a new paradigm in healthcare services,” added Mariappan. prathiba.raju@expressindia.com
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cover ) I N T E R V I E W
HLL Lifecare will soon come out with a medipark in Chengelpet,Tamil Nadu, which will be spread across 330 acres in plug and play model.The development cost of the medipark is ` 160 crore.The facility will have a integrated vaccine complex in 100 acres, which will produce vaccines needed for UIP
‘We provide project management consultancy for construction and upgradation of hospitals, medical colleges and labs’ RP Khandelwal, CMD, HLL Lifecare, in a wide-ranging interview, talks about the transformation of HLL Lifecare from a condom manufacturing company to a full-fledged healthcare delivery company, in an interaction with Prathiba Raju
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What major works have been undertaken by HLL Lifecare since its inception? HLL Lifecare is a Miniratna company, which started manufacturing condom in 1966. We implemented Government of India’s family welfare programme and soon we started manufacturing an entire range of contraceptives. We then diversified into hospital management products viz blood bags, stents, diagnostic kits – pregnancy test kits, malaria test kits. We forayed into the pharma sector by introducing oral contraceptive pills and acquired Go Antibiotics, which as a pharma unit produces generic medicines and antibiotics.
HLL Lifecare also entered into service segment and became a full fledged healthcare delivery company. We provide project management consultancy for construction and upgradation of hospitals, medical colleges and labs. Right now, we have ` 10,000 crore-worth project in our kitty. We were instrumental in setting up six AIIMS and constructing three new AIIMS in Bathinda, Gorakhpur and Guwahati. HLL also has seven manufacturing units. We are the national procurement agency for the Ministry of Health and Family Welfare (MoH&FW). We procure high-end medical equipment for central institutes like
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AIIMS, PGI Chandigarh, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER) and all major state government institutes. We have biomedical services, deliberation, training, testing of all medical equipment. HLL Lifecare also provides facility management services like housekeeping, catering, laundry of the medical institution. What kind of challenges did you face while setting up AIIMS? Right from procuring land, we faced a lot of challenges. Though it is a government land, there were encroachment issues which we had to clear and from then each step needed approvals. Getting municipal approval for the architecture, green tribunals litigation are few of the issues we faced during the planning stage. Apart from these, getting the right contractor is a biggest challenge. We give preference to professionals like L&T, Ahluwalia Constructions and Shapoorji Pallonji. It takes 18 to 24 months to construct a project. Being a procurement consultant and simultaneously taking care of the installation of equipment, HLL Lifecare synchronises the work. For example, by the time buildings are built, we get ready with the equipment to be installed. In order to monitor various construction projects, a new software Primavera software has been installed and we have video conference facility as well. How HLL Lifecare is different from all other Project Management Consultants (PMC)? HLL Lifecare is different from all other PMCs like HSCC, NBCC India, as we have a complete range of infrastructure facility, facility management and added to it, we have a big team of biomedical engineers. We not only construct buildings, but also equip and assure to maintain the building for over 10 years. It makes a lot of difference compared to other companies as they look only after construction, whereas we provide a comprehensive consultancy. Four years back, the Health Secretary of MoH&FW suggested that whoever constructs the building should maintain it for five years but it was just a guideline and was not made mandatory. What is the status of the three AIIMS which are under construction? The three AIIMS in Gorakhpur, Bathinda and Guwahati are designed in built-run model. We have just started and in the process of appointing an architect. Once the design is approved, we will identify the contractor. It will take around six months to start the construction and to construct it will take 18 months. To make it fully functional as a medical college, it will take three years. Already HLL has constructed six AIIMS as in-house consultants. The building of AIIMS pan India is an initiative to bring in the tertiary healthcare facilities to the doorstep of the people. It will fill the healthcare gaps as it will have state-of-the-art facilities and best doctors available in the state level. Apart from it, we are upgrading the medical colleges under Pradhan Mantri Swasthya Suraksha Yojana (PMSSY) so they are at par with AIIMS. In Phase I and II, six medical colleges were upgraded, under Phase III, 12 medical colleges will be upgraded. The government wants to provide facilities of super speciality hospitals by up-
HLL Lifecare will take into industrial production and commercialisation of the three medical devices -Blood/IV fluid warning system, a thermo regulated infant warming bassinet, and thermo regulated infant warming wrapper grading these medical colleges. What is the status of free diagnostics projects taken up by HLL Lifecare in Maharashtra and Assam? In two states, Maharashtra and Assam, we are running the free diagnostic programme. In Maharashtra, we will establish 112 labs — 51 major labs, 61 mini labs and one major reference labs. We will have 2300 centres which will cover Primary Health Centres (PHC) in 33 districts. We have already set up 18 labs and by the end of July, all the labs will be operational. In Assam, we have set up 10 labs, 1000 centres will be covered, which will be operational by the end of July. The project will be monitored on a real-time basis by IT-enabled systems, which will track the details of patients’ samples collected from the collection centre to the lab for testing and reporting. Anybody who requires any diagnostic test can approach these centres and conduct their test for free, as the expense will be borne by the state government. It is a National Health Mission (NHM)-related project. Through a tendering process, HLL Lifecare competed with private players like Dr Lal Pathlabs, Thyrocare, Metropolis,and was able to bag the project. It comprises an entire range of pathological tests. The cost is low and by paying only ` 199, one can do any number of test. We will receive the the payment from the state government on per patient basis and not per test. So, the idea is to reduce the out of pocket expenses. HLL Lifecare is also starting Mobile Medical Unit (MMU) in Assam this month. Can you give us details about the project where sanitary napkin vending machines and its incinerators are installed in government and aided schools. As per your experience, which state government is at the forefront when it comes to healthcare-related projects ? HLL Lifecare’s VENDIGO is a sanitary napkin vending machine, which is a state-of-the-art, fully automated and electronic machine. Its unique features will dispense napkin (pack of three pads) on the press of a button. They are also installed in government offices where they have been priced at ` 10. A pack can be available on inserting a ` 10 note or coins of ` 1, 5 and 10. We have installed the machines in Kerala, Andhra Pradesh and Rajasthan. We are approaching various state governments to install these machines in schools,
colleges, offices, hospitals and hostels for women and girls. They are also promoting safe and environmentfriendly disposal of used napkin pads by providing sanitary napkin incinerators. Healthcare being a state subject, it depends on the state chief minister and health ministers. Headquartered in Kerala, we do a lot of programmes for the state. Apart from it, Assam, Maharashtra, of late Uttar Pradesh, has shown interest in setting up such facilities. HLL Lifecare is also into industrial production and commercialisation of three medical devices Blood/IV fluid warning system, a thermo regulated infant warming bassinet and thermo regulated infant warming wrapper. So, how will it help the general public and particularly paediatric medical services? HLL Lifecare will take into industrial production and commercialisation of the three medical devices -Blood/IV fluid warning system, a thermo regulated infant warming bassinet, and thermo regulated infant warming wrapper. We have signed the technology transfer agreement with Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTMST). We have to commercialise the devices andwill set up a unit in Thiruvananthapuram (Kerala) or in Chengelpet (Tamil Nadu). What is the status of the Medipark project, the first manufacturing cluster in the medical technology sector in the country in Chengelpet (Tamil Nadu)? The Cabinet approval for the medipark project came only six months back and we had immediately applied for environmental clearance. We are expecting to get the clearance in the month of July. The medipark will be set up in 330 acres in plug and play model. The advantage of this land is that it has water, power, road availability and we just need to develop the park. The master plan is already prepared. We will have a common knowledge park, incubation and testing facilities will be set-up. We are also in talks with Drug Controller General (India) (DCGI) to open theiroffice as it will be accessible for for domestic and international companies. As per the Cabinet order, the project should be completed in three phases in seven years. The Phase I will be completed in three years, Phase II – three years and Phase III – two years. The development cost of the medipark is ` 160 crore. The entrepreneurs who wants to set up will be charged by per acre, so we can recover our cost. The facility will also have a vaccine complex. The project is coming up under HLL Biotechnology, a subsidiary company. Nearly 100 acres will be given to the integrated vaccine complex. The idea is to take care of the universal immunisation programme of the Government of India. Pentavalent, rabies, measles, hepatitis A virus (HAV) and hepatitis B virus (HBV), JE and BCG vaccines will be produced. The validation and clinical process is going on and the first vaccine is likely to be out by April 2018 and most of the vaccines will be out by 2020. The budget for vaccine complex is around ` 710 crore. prathiba.raju@expressindia.com
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cover ) I N T E R V I E W
‘We are now scouting for business abroad as well as neighbouring countries’ HSCC India has achieved a rapid manifold growth over the last five years and established trust and confidence of its clients. Gyanesh Pandey, CMD, HSCC, in an interaction with Prathiba Raju, elucidates about various projects handled by the Miniratna company Usually PSUs are blamed for a lackadaisical approach and they are termed to be low performers compared to private players. HSCC is set to have changed the trend. Can you share the secret? Well, the secret of our success is only the sincere effort, hard work and team effort due to which we are able to deliver the projects on time with maintaining the quality and are within the approved cost . By increasing employee efficiency and making each employee result oriented, enables us to become more competitive among our peers. How do you choose the projects? How many projects are right now in your kitty and their worth? HSCC has the experience of creating a diverse range of hospital infrastructure including cancer, cardiac care, mother and child, burn, trauma, emergency, OPD, neurology, orthopaedics, respiratory, AYUSH, UNANI, ayurveda, homeopathy, etc. HSCC is instrumental in setting up BSL-III & BSL-IV Lab in India for the first time. HSCC adopts the twin criteria in choosing projects – the first being our commercial interest and other our professional satisfaction. To have a regional spread, we are now scouting for business abroad as well as neighbouring countries. The total healthcare projects in our kitty are more than 100, aggregating an excess of ` 15000 crores.
HSCC has been giving importance to technology. You are coming up with a completely paper-free hospital in Delhi. Can you give us details on the same? What kind of technology up-gradation is HSCC promoting? The concept of paper-free hospital in the private sector is already in place, in public sector hospitals the paper-less concept along with IT networking is now gaining ground. Almost every hospital that HSCC now develops has IT infrastructure and paper-less concept. The two major projects recently completed by HSCC that have this paper-less technology concept are Kalpana Chawla Govt. Medical College, Karnal, and a 1300-bedded Emergency and SSB Block at Safdarjung Hospital, New Delhi. What kind of challenges did you face while building up AIIMS like big projects in India? The major challenges faced by us while executing big projects is fewer agencies that can handle such a quantum of work. Moreover, smaller agencies are not upto the mark and for bigger value of work, very few are available. Availability of labour in new places is less hence desired possibilities of work is hampered. The approach of such smaller agencies to deliver the quality of output for bigger projects often lacks the output capability of professional agencies. Also lack of skilled labour hampers the work. What is the USP of HSCC compared to HLL
The major challenges faced by us while executing big health infrastructure projects is that we have fewer agencies that can handle such quantum of work. Also the lack of skilled labour hampers the work
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(
FO C U S : P S U H O S P I TA L S
MAJOR WORK UNDERTAKEN BY HSCC SINCE 1983, HAS TRANSFORMED OVER THE DECADES. IT CAN BE PLACED UNDER THREE DISTINCT GROUPS: ● Period 1983 - 1994 HSCC did little consultancy work of procurement and design engineering only. However, the major projects handled during this period were : ◗ Jawaharlal Nehru Hospital, Mauritius ◗ 500-bedded Dimapur Govt. Medical College ◗ Peerless Hospital in Kolkata ● 1994 – 2011: During the period HSCC also started rendering project management consultancy of hospitals in addition to design engineering consultancy. The major projects during this period undertaken included: ◗ Bhopal Memorial Hospital and Research Centre, Bhopal. ◗ NEIGRIMS, Shillong ◗ NIB, Noida ◗ The Sports Injury Centre ◗ VMCC, Safdarjung, New Delhi ◗ Trauma Centre, New Delhi ◗ Nursing Quarters, Srinivaspuri ◗ PGIMER, RML Hospital
Karnal Medical College
Safdarjang Hospital, New Delhi
Lifecare Limited (HLL) and NBCC India? The USP of HSCC compared to HLL and NBCC India, is the experienced and competent people working here in the field of healthcare infrastructure. Generally other agencies hire external consultants for conceptualising and detailing of their hospitals and laboratories but HSCC is able to make all such conceptualisation and details within a very short period of time with the help of its in-house experienced architects and design engineers. HSCC also has experienced agencies in project management consultants (PMC) which ensures quality and timely delivery of projects. Moreover HSCC is focussed only on healthcare infrastructure projects instead of other infrastructure works. Being a world class consultant in health sector, what are the plus points, pain points and challenges you face while you work for India compared to other countries? Definitely, we are building such hospitals which are compared to the hospitals of developed countries but the pain remains the same. Sometimes this aspect is not recognised by various clients and authorities while inviting
tenders for construction of healthcare projects. As such, companies working in other sectors, like manufacturing, metallurgical, railways, housing, steel structures, bridges, highways etc. also get considered along with HSCC which is actually not their expertise. What is the status of the upcoming AIIMS which are under construction in Guntur, Kalyani and Nagpur? The Guntur, Kalyani and Nagpur AIIMS are under tendering process and execution of work is expected to start soon. HSCC has achieved a healthy turnover growth of 92 per cent to ` 1,106 crore in FY16? What is your expectation in the upcoming fiscal and what are your action plans for it? Emboldened by the company’s consistent growth in performance in the last quinquennial, our expectation is that HSCC sustain performance by way of diversifying and expanding its business areas and continuing efforts to build up national healthcare infrastructure.
● 2011 to till date: During the period, HSCC has aggressively marketed and undertook diversification. It secured various mega projects and also completed most of these. ◗ AIIMS, New Delhi : (Underground parking, surgical block, mother and child block, OPD block, geriatric block, emergency, trauma centre expansion, burns and plastic surgery centre.) ◗ National Cancer Institute, Jhajjar ◗ CNCI, Kolkata ◗ RIMS, Imphal ◗ Mental Health Hospital, Tezpur ◗ Cancer Hospital, Shillong ◗ RIPANS, Aizawl ◗ 500-bedded Hospital , Itanagar ◗ Kalpana Chawla Govt. Medical College, Karnal ◗ Expansion of 1300-bedded emergency and SSB Block, Safdarjung Hospital, New Delhi. ◗ Expansion of RML Hospital , New Delhi ◗ AIIMS at Raipur, Rishikesh and Bhubaneshwar ◗ New AIIMS at Guntur, Kalyani and Nagpur ◗ Up-gradation of PMSSY projects at 19 different locations across the country. ◗ 200-bedded Dickoya Hospital , Sri Lanka ◗ 200-bedded Hospital at Kathmandu, Nepal ◗ 200-bedded ENT Hospital , Mauritius ◗ NIAB, Hyderabad ◗ NIMHANS, Bangalore ◗ SAT, Thiruvananthapuram ◗ Mother & Child Hospitals in Himachal Pradesh, Kerala, Uttar Pradesh, Chattisgarh ◗ Medical Colleges at Chamba, Nahan, Mirpur in Himachal Pradesh ◗ Medical College at Pali, Rajasthan ◗ Medical College, FALKAWN, Mizoram ◗ Medical College, Itanagar ◗ 500 bedded Hospital in IIT, Kharagpur ◗ ESI Hospital , Siliguri etc
prathiba.raju@expressindia.com
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POLICY WATCH I N T E R V I E W
‘I would not tolerate corruption in the healthcare service delivery On the completion of 100 days in office, the Uttar Pradesh government has given a major focus to revamp the healthcare system. In an exclusive interview, the state’s Health Minister Siddharth Nath Singh, shared with Mohd Ujaley the state’s initiatives to tackle the challenges such as shortage of doctors, and infrastructure What are your key priorities in the healthcare sector in the state? Our first priority has been and hopefully I have succeeded, to change the image of the ministry. The ministry was known for corruption, inefficiency and lacklustre attitude. But now the ministry is known for delivering healthcare services. There has been image makeover of the ministry. Secondly, there are many areas where the health services need to be improved. Availability of the doctors, medicine, technicians are key for this improvement. However, we have shortage of 7000 MBBS doctors and 18000 paramedicals staff. Now to overcome that there we are coming out with a two prong approach – focus on human resource and technology. On the human resource side, it is about getting more doctors but that does not mean that we would recruit doctors, as the shortage is about 7000 doctors. So, the only way is to use the existing doctors and infrastructure to the optimal. It means if there is a morning OPD, there should be an evening OPD too. So that more people can get medical services. I am also talking to Indian Medical Association (IMA) for hiring their doctors on honorarium basis. In addition, to fill this gap, we are mulling to start walk-in-interview system rather than fully depending on the Lok Seva Ayog (Public Service Commission). The Lok Seva Ayog will continue. We are trying to fill the gaps
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in healthcare service delivery, using telemedicine. Very soon, we will come out with a tender to roll-out telemedicine services across the state.
tors are there then the appointment comes. If the doctors are not there what will I do with the online appointment system. So, I am very clear about what I want to do. The shortage of 7000 doctors needs to be fill by various method.
In Uttar Pradesh, you already have Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow with dedicated telemedicine facility. Why don't you use them rather reinventing the wheel? Yes, it is there but that is very small. When you talk about telemedicine, it has to be universal. It must touch the primary healthcare (PHC), not just the medical colleges. NHM envisaged to have at least one MBBS doctor at PHC level but doctors are reluctant to go there. How do you plan to address this challenge? If an MBBS doctor goes to PHC, its great. If they can't go, we have to find a way to address this challenge. I am coming up with a policy where we will allow Bachelor of Unani Medicine and Surgery (BUMS) doctors to serve at PHC level. To smoothen the patient interaction with the doctors and hospitals, All India Institute of Medical Sciences (AIIMS) and few other government-owned hospitals have started online appointment system for OPD and clinics. Is Uttar Pradesh also plans to do that? Going forward, we are going to come up with many technology
The state government will come up with many technologydriven things, which will help us in delivering better healthcare services in the state driven things that will help us in delivering better healthcare services in the state. But at this stage, we have to go step by step, we cannot do everything together. First step is that we must have doctors. If the doc-
All these need a lot of investments in health delivery system in the state. How do you plan to fund your programme? We have inherited more or less empty treasury. I am looking at various other models including public private partnership (PPP) and help from central government which they have promised under various programme of National Health Mission (NHM). To be honest, I am grateful to Union Health Minister J P Nadda, he has given a helping hand to me in our endeavour to overhaul the health service delivery in the state. Under Make in India programme, the Union government is incentivising both the states and private firms for setting up manufacturing plants in India. Are you planning to promote that? I know that government of India is promoting local manufacturing under Make in India programme but it is little different. It is not related with the health services. That is related with the industrialisation programme of the government. Government of Uttar Pradesh is very soon going to come up with an industrial policy which
will have components like industrial park and different economic zones. If people want to set up pharmaceutical plant, they can. Many people have already approached us. But that is not related with the health ministry. It has more to do with the industry and investment promotion. We are primarily concerned about the healthcare service delivery in the Uttar Pradesh. As a health minister, in coming two years, what would you like to achieve? My priorities in two years would be to put entire healthcare system and health service delivery of Uttar Pradesh back on track and running. That counts everything – including doctors, paramedical staff, technicians, all the machines and test equipment like Digital X-ray, CT Scan, MRI Scan etc. I will try to put all these things in the hospitals. Second, I would not tolerate corruption in the healthcare service delivery. Throughout the state the hospitals will be upgraded. I have personally upgrading the Lal Bahadur Shatri Chikitsalaya in Varanasi. Apart from it out of 173 district hospitals, 10 hospitals will be upgraded by World Bank. That pilot project hopefully is going to be successful by September this year. We are hopeful that they will take up the remaining hospitals as well. I am also in discussion with Asian Development Bank (ADB) for them to give us helping hand. mohd.ujaley@expressindia.com
Banking on human milk MoH&FW is planning to open a network of human breast-milk banks pan India, finds Prathiba Raju
CK Mishra, Health Secretary, releases the guidelines on human milk bank at the inuaguration of Vatsalya – Maatri Amrit Kosh at Lady Hardinge Medical College in New Delhi
‘V
atsalya – Maatri Amrit Kosh’, a National Human Milk Bank and Lactation Counselling Centre at Lady Hardinge Medical College (LHMC), will be the largest human milk bank and lactation counselling centre available under the public sector in North India. Inaugurating the centre at LHMC in Delhi recently, CK Mishra, Health Secretary, envisaged that with this donor human milk bank, all newborns in and around Delhi will have access to life saving human milk regardless of the circumstances of their birth. “Even when we know the potential of mother’s milk for a child, breast feeding rates are low in India. The early initiation of breastfeeding is only 40 per cent, even when the institutional delivery has increased to 78.9 per cent. In view of this, we launched Mothers Absolute Affection (MAA) programme to create awareness regarding breastfeeding as being the most cost-effective way of enhancing the child’s immunity,” Mishra stated. Mishra further said that the decline in maternal and child
CK Mishra, Secretary, MoHFW : With this donor human milk bank, all newborns in and around Delhi will have access to life saving human milk regardless of the circumstances of their birth mortality in India is much faster than the global average rate of decline and thanked the frontline workers for their dedicated work. “We are poised to enhance Universal Health Coverage in the country and are conscious of quality issues. Several efforts are underway through NHM to improve affordability, quality and access to healthcare services. This is one such initiative.” The national human milk bank and lactation counselling centre will collect, pasteurise, test and safely store milk that has been donated by lactating mothers and make it available for infants in need. In addition, this facility will protect, promote and support breastfeeding of their own healthy mothers by providing lactation support to mothers through dedicated lactation counsellors.
Elaborating on the human milk bank facility, Sushma Nangia, Director, Professor, Head department of Neonatalogy, LHMC told Express Healthcare, “Human milk banks assume great importance in our country, as it significantly helps in the infant mortality rate, particularly the pre-term babies who are significantly under-weight. And the physiological inability of the mother in many cases to breastfeed, the human milk bank helps. In LHMC alone, we have 14,000 mothers delivering each year and per month it is 1400 deliveries and 30 to 40 deliveries per day. With the NICU having about 80 babies, the human milk bank comes as a boon to pre-term babies, as it ensures healthy and safe milk.” Informing that Vatsalya – Maatri Amrit Kosh is more of a lactation management centre
and that human milk banking will be a part of an overall breastfeeding strategy, Nangia said, “The lactating mothers who have excess milk volunteer and donate the milk. First step donors blood is tested for HIV 1 and 2 and Hepatitis B and C. Operations of storage, pasteurisation, checking contamination, and monitoring of milk are done with utmost care. The milk is pasteurised at 62.5 degree celsius for 30 minutes. This special method of pasteurisation kills potentially harmful viruses and bacteria but does not harm the majority of the milk’s immunological properties and beneficial components. The nutritional composition remains unchanged. After processing, a bacterial culture is completed to make sure that there are no harmful bacteria remaining in the milk. The milk is frozen and
held at -20 degree celsius until it is requested for the use. The milk is pasteurised and re-cultured before it is dispensed. As of now, we get 60 ml to 200 ml milk from eight to 10 mothers. The milk is given on requisition basis to the nurse in the neonatal intensive care unit (NICU) unit. While the infrastructure facility was taken care by the LHMC, the equipment viz, breast pumps, pasteurizer, sterliser and heater was given by The Norway- India Partnership Initiative (NIPI).” Vatsalya – Maatri Amrit Kosh is established in collaboration with the Norwegian government, Oslo University and Norway India Partnership Initiative (NIPI). “I am confident that this will provide guidance, inspiration and guidelines for more such milk banks for helping sick newborn babies,” said Nils Ragnar Kamsvag, Ambassador of Norway to India. “This centre will also act as the teaching, training and demonstration site for other milk banks to be established under the MoH&FW,” Mishra added. prathiba.raju@expressindia.com
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STARTUP CORNER I N T E R V I E W
‘By Dec 2017, we will venture into Bengaluru, Chennai, Hyderabad and Mumbai’ Tenzin Thargay, Co-founder, LetsMD, a healthcare fintech start-up, in an interaction with Prathiba Raju, elucidates on how the company aims to make healthcare accessible and affordable to 50 per cent of India’s population which doesn’t have access to tertiary-level care due to unavailability of immediate liquidity What made you venture into healthcare financial start-up? LetsMD focuses on small scale hospitals and 90 per cent of our clients are from small hospitals. As these hospitals work more like rental shops, LetsMD supports them to establish a robust customer relationship management (CRM) and help them attract nearby patients. Today, 50 per cent of the rural population in India and 30 per cent in urban India go for loans or sell assets to pay their hospital bills. Large PSU banks are more inclined to corporates, and personal loans for the salaried class. This is the reason why micro finance institutions are faring better in one or two states in South India, while in North India, the picture is grim. Bajaj Finserv provides personal loans and SRE, Fullerton, Sriram Funds are inclined to infrastructure finance. A lot more needs to be done in medical loans and this is where we want to make our presence felt. How has been your journey been so far? What are your expansion plans? LetsMD was started in 2015 and the focus for the first 12 months has been to establish itself in the Delhi NCR. We are in the process of completing Series A funding from a venture capital group. By December 2017, we will venture into four more cities Bengaluru, Chennai, Hyderabad and Mumbai. Right now,
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Today, 50 per cent of rural population in India and 30 per cent of urban India take loans or sell assets to pay their hospital bills. There is a huge demand for medical loans and we want to cater to the market we have nearly 40 elective surgeries in our kitty and we hope to cover 80 per cent of the tertiary care infrastructure in every city where we have our presence. Eight per cent of India's tertiary care
hospitals are in 20 cities and it will cover these target cities over the next three years and expand the surgery basket to 100 elective procedures. How do you want to bring
formal financial services in the health sector? We don't provide cost of surgery as we don’t have the inventory. LetsMD covers 40 and above elective procedures like IVF, cataract, lasik, knee replacement, gall bladder surgery. Elective surgery is more like FMCG products as everybody knows about IVF, cataract where the cost of surgery do not extend more than 5x. If an IVF procedure costs `2 lakh, LetsMD offers an EMI of `5000 per month. In cataract surgery, which costs `50,000, the EMI comes down to `4000 per month. We have created a subventionbased loan, where a person pays `50,000 for a procedure through EMIs. Across Delhi and the NCR, we have tied up with 300 super speciality hospitals. We get 10 to 15 per cent hospitals per procedure, for example for `1 lakh procedure we earn `10,000 to `20,000. From each medical loan, we earn 15 to 20 per cent, where five per cent is from the customer and 15 per cent from hospitals. There is no financial innovation in the healthcare sector. Your comments. The government-run health schemes like Rashtriya Swasthya Bima Yojana (RSBY), Central Government Health Scheme (CGHS) and Employees State Insurance Corporation (ESIC) cover only 15 to 20 per cent of the population and the treatment coverage is less. Meanwhile, in the
private health insurance space, insurance offered by ICICI Lombard covers only a few of them. Some large public sector entities give good health insurance cover but a majority of the private companies which have 100 to 500 employees, do not treat health insurance as a priority. Insurance has less penetration in India in comparison to many other countries. The government's focus is not very clear when it comes to insurance. It should introduce innovative PPP initiatives. With ease of communication, people are increasingly trying to adopt technology and are willing to pay for good health services. What are the benefits of LetsMD? First is transparency in pricing and the second is trust. Healthcare is such an area that any medical graduate can set up a hospital, there is no stringent evaluation. Though NABH checks hospital infrastructure, OTs, beds, there is zero focus on clinical outcomes. LetsMD focuses on building trust with the patient by giving a ground report of the hospital and the surgeons. We have a team that visits each hospital and checks the equipment. We also have a question bank to ask the doctors and check the authenticity of the hospital. We have a team of five senior MBBS doctors, who verify and analyse the data. prathiba.raju@expressindia.com
STRATEGY I N T E R V I E W
Zitqitza Healthcare will grow at 30 per cent in 2017-18 Zitqitza healthcare has been one of the success stories in the PPP segment and are now making their mark in the ambulance outsourcing space. Naresh Jain, CEO, Ziqitza Healthcare and Manish Sacheti, CFO, Ziqitza Healthcare, share the success strategy with Raelene Kambli Zitqitza Healthcare has been expanding its ambulances outsourcing business. What is your vision to take this forward? Jain: Currently, hospitals have come to the realisation that managing ambulance services is a very difficult and cost consuming task. Managing more than two to three ambulances at times shifts the force of the healthcare provider. Many a times hospitals complain that when they require an ambulance either the driver is not available or there is some or the other problem. Even the maintenance of these services involves a huge cost component. That’s why an outsourcing option can be beneficial. Hospitals receive an ambulance when they need it and there is an agency responsible. For the entire service which saves them time, cost and more importantly ensure better quality of service. Where the market is concerned, this segment has immense opportunity both in the private and in the public sector. Players such as EMRI has been primarily focusing on the government sector and therefore we find great value in the private sector as there are very few players in this space. This trend has picked up momentum across India and therefore the focus on this business segment is expanding. We are tying-up with private hospitals chains, large corporate houses from various sectors, industrial plants, warehouses and large organisation with more 3000 employees as well as PSUs.
More so, we are also partnering with startups such as Flipkart, etc., to provide them with our ambulance services. How much does ambulance outsourcing contribute to your total revenue? Jain: Although this segment has huge potential, we still need to make in roads in the market. Primarily, this business requires a huge investment and that is a constrain to the growth. Currently, this business contributes to around 1520 per cent to our overall business. What is Zitqitza Healthcare's overall turnover in 2016-17? Sacheti: The turnover for Ziqitza Healthcare in India for FY2016-17 was close to Rs 193 crores. This includes the PPP business, private ambulance service, ambulance outsourcing business and EMT training services. What are your projections for 2017-18? Sacheti : We are looking forward to grow at 30 per cent in 2017-18 and working hard to achieve the same. What is your opinion on venturing into the air ambulances services to expand your business? Jain: Well currently, we are focusing on expanding our outsourcing business. Nevertheless, there is scope in this segment too and we will be exploring opportunities in this space at a later stage. Ziqitza Healthcare has been a
government and this has helped us achieve success. What are the advantages of the tender model? Jain: Well, the tender model sets clear guidelines for the business process. It has defined goals for each party and has clear deliverables. This ensures that both stakeholders are responsible for the success of this project. Moreover, it also ensures smooth functioning of the various stakeholders involved in the process.
Our ambulance outsourcing service is to around 15-20 per cent of our total business
The turnover for Ziqitza Healthcare in India for FY2016-17 was close to Rs 193 crores
successfulin its PPPs. Tell us your mantra for success. Sacheti: There is no magic mantra to success and like all businesses we put in our best efforts and hope for good results. The partnership with the government is no different except that there are extensive processes and protocols involved. While the government has a very robust framework for the scope of work, one needs to understand that we face a lot of unexpected events and our drivers and paramedics have to tackle these unforeseen situations with quick decision independently. Infrastructure development also plays a very important role in ensuring the overall quality of services.
Hence, we need to work in cooperation with the government to make sure that we get their support to offer the best services to the people. We have been in this industry for over a decade and hence, we understand the fundamentals of the ambulance business, which helps us to service the sector better. The PPP model introduced by the government is a transparent model as compared to the MoU model. This model helps in increasing efficiencies and competency contributing to a successful partnership. Jain: Right from the beginning, we have opted for the tender model to do business with the
Tell us about the number of partnerships with the government? Sacheti: We have signed five contracts with the government under the public-private partnership model. The states where we have partnered are Punjab, Jharkhand, Odisha, Madhya Pradesh and parts of Bihar. How much time do you take to have your ROI in this business? Sacheti: We are in the business of saving lives and though earning profit is one of our objectives, it is not our only objective. We put in our best efforts and all required investments in upgrading our services to increase efficiency from time to time. There are certain guidelines and protocols which are set by the government with regards to the payments. We adhere to these guidelines hence the payments come in as scheduled by the government. raelene.kambli@expressindia.com
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STRATEGY I N T E R V I E W
NCDs are not given the priority they should be in India Harald Nusser, Head, Novartis Social Business, has been actively involved in running the Novartis Access programme for India. He explains how the access programme will add value to the efforts taken by the government to improve healthcare in India in an interview with Raelene Kambli Tell us about the Novartis Access programme and its aim to increase access to healthcare? We launched Novartis Access 1 in 2015 to curb the growing incidence of non-communicable diseases (NCDs) in lower-income countries. Often, people don’t realise the huge and rising impact chronic conditions like diabetes, respiratory illnesses or cardiovascular diseases have in these countries. Part of the reason is that historically infectious diseases have been the focus of health systems in lower-income countries. Although the global health community has made tremendous progress in fighting infectious diseases2,3 in the past decade, there’s still a
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NCDs are colossal obstacles to the long-term sustainability of developing countries – perhaps even more so than infectious diseases. By 2020, NCDs will make up 80 per cent of the global disease burden lot of work to be done. And now with chronic diseases, lowerincome countries are facing a double disease burden. Beyond the human suffering they bring, NCDs are colossal obstacles to the longterm sustainability of developing countries – perhaps even more so than infectious diseases. By 2020, NCDs will make up 80 per cent of the global disease burden. Seven out of every ten deaths from NCDs will be in developing countries. Around half of these will be premature4 and this will equate to a massive loss of productivity. It has been estimated that NCDs will cost the world $ 47 trillion by 20305. Much of that cost will be borne by developing countries and their people.
You are planning to launch your programme in 21 countries. What lesson do you bring for India's healthcare system? We’re hoping to roll out Novartis Access in 21 countries by 2020, but the programme is actually only being rolled out in Kenya at the moment. Till now, in addition to Kenya, we signed memoranda of understanding with Ethiopia, Rwanda and Pakistan. We are also having discussions with major countries in Africa, Asia and Latin America. In the meantime, we’ve commissioned Boston University to assess the impact of the programme in Kenya6. A team led by Professor Richard Laing will be in charge of the study, looking at how successful the
rollout of Novartis Access has been in Kenya. The study will take place over two years, involving a randomised controlled trial and interviews with patients and healthcare workers. The study’s findings, which will be available to the public, will form the crux of our future efforts and the expansion of Novartis Access into other countries in the coming years. Once we have that evaluation, we’ll be able to see what has or hasn’t worked in Kenya and, from there, refine the programme, making sure it’s efficient and costeffective. You have an elaborate programme for Kenya, Ethiopia and Rwanda. How different are the healthcare
systems of these countries from India? Healthcare systems have to be different to work in different places. That’s not only true on a country-by-country basis; it’s true within countries. In India, for example, you’ll find what works in an urban setting like Mumbai or New Delhi won’t work in rural communities in Uttar Pradesh. The socio-economic reality being so different from one place to another, people have very different healthcare needs. In terms of comparing India with the countries you mentioned, there are similarities and there are differences. Kenya and India are similar on the basis that, in both countries, health is managed on a provincial level. In Rwanda, on the other hand, you’ve got quite a centralised system7, with responsibility for healthcare policy and planning at the executive level. This is a contrast with India, where the constitution puts responsibility in the hands of state governments.8 Fundamentally, I would say the main difference between India and the three African countries you’ve mentioned is scale. India has the globe’s second-biggest population, with 1.3 billion people9. By contrast, Ethiopia has a population of 104 million10; Kenya 48 million11; and Rwanda 12 million12. India is also a far wealthier country – its nominal GDP is the seventh largest in the world; if taken in terms of purchasing power parity, India ranks third13. It also has the world’s highest number of people living below the poverty line in the world14. This is particularly applicable to its rural population, where healthcare accessibility and
STRATEGY delivery is lacking. There’s a shortage of doctors and other medical personnel, and people often have to pay out of pocket to fund their healthcare expenditure. The rising threat of NCDs in India will make this situation even worse, because NCDs are generally chronic conditions requiring treatment over many years. Diabetes is perhaps the best example of this. To combat diabetes, we need reliable access to diagnosis, care and treatment, with often life-long follow-up. But, we also need education – raising awareness among people, in rural and urban India alike, so that they make better lifestyle choices and minimise their risk of becoming diabetic. How do you conduct your access programme in these countries? We provide a portfolio of 15 treatments at very low cost – one dollar per treatment per month to public-sector customers15. Novartis Access medicines target the four main types of NCD – breast cancer, cardiovascular diseases, diabetes, and respiratory illness. The treatments include both on-patent and off-patent medications. Beyond the medicines, we also look toward training community health workers (CHWs). This is important because in many lower-income countries, there are shortages of healthcare professionals. Almost half of WHO member states have less than one doctor for every thousand people16. This has been a longstanding trend, but despite this we’ve seen major progress in reducing the impact of infectious diseases. This can be attributed, at least in part, to the work of CHWs – who thus far have been trained to deal largely with communicable diseases. We believe there is a great potential for these workers to transfer their skill over to chronic disease with the appropriate training. We are already partnering with governments and NGOs to build capacity, and will continue to work with them on it.
A key element of Novartis Access is supply chain improvement. Long-term conditions often require that people take medications on a daily basis. It is thus critical that they get hold of these treatments even in remote rural areas. We also take steps to ensure that middlemen do not mark up the very low prices we have set, to ensure medicines remain affordable to the end user. And how are these programmes different from your programme in India? Our focus in India at the moment is Arogya Parivar, which is our Healthy Family initiative. We launched this programme in 2007 to reach out to rural India, where the population is the most underserved in the country in terms of access to healthcare. It’s about improving the quality of life of millions of Indian villagers. And we’ve seen that happen. The outreach work we did in 2015, for example, got seven million villagers in eleven states into more than 125,000 meetings run by health educators trained by Novartis. It also managed to get more than 580,000 people into nearly 10,000 health camps, of whom 60,000 went to a physician afterwards. We have shown that it is possible for those living at the bottom of the pyramid to participate in the health market, if a sustainable marketbased approach is customised to their needs. We, ourselves, broke even within 30 months of the programme’s launch, which means Arogya Parivar has long-term sustainability built in at its core. Now we are exploring ways of integrating Novartis Access products against NCDs into the programme. Already, we’ve managed to cover Indian villagers across, with the provision of 100 products against diseases that are prevalent in rural India. You say that your access programme brings down the cost of healthcare, can you elaborate on the same? One of the primary obstacles to treating NCDs in a lower-income country is the perception
Our programme reduces the cost of treatment, whilst improving supply chains that healthcare is unaffordable. Our programme reduces the cost of treatment, by making high-quality medications available at low prices, whilst improving supply chains so that the people who need these medications get them when they need them. We are also able to mobilise individuals to take better care of themselves by educating them at health camps and community meetings run by trained community health workers. A lynchpin of our NCD-targeted programme is taking healthcare systems and treatment models which worked for infectious diseases and adapting them for the NCD threat. This involves the training and supply chain improvements I previously mentioned. Another important aspect is that most healthcare costs come in the form of staffing, buildings, IT, etc. One thing to clarify is that our work in no way takes away from the requirement for governments and other healthcare providers to invest their personnel and infrastructure. That is why it is so important that we partner effectively with health providers, so that a cohesive approach is undertaken and patient benefit is maximised. What are the challenges faced by you in the successful execution of this programme in India? Well, India is a huge country with a very large population. This makes it very difficult to simply implement Novartis Access. As with our other programmes, effective partnerships will be the key. I would
not rule out ever working with one of the states. The main challenge, I would suggest, is that NCDs are not given the priority they should be in India. They account for more than half of India’s disease burden and are potentially building a public health crisis for future generations.
ing in India, but there are no plans to do so in the immediate future. However, we would certainly be more than happy to talk with the Indian government, on a federal or state level, if they would like to find out more about our programmes and how they are working on the ground. References:
Do you think independent measurement of access programmes can help ensure their success to achieve the SDGs for India? I think this is absolutely critical. Too many pharmaceutical companies set up access-tomedicine initiatives whilst failing to generate any kind of independent study or insight into how effective these programmes really are. They can be ambitious, they can be innovative, but this means nothing if they are not effective. Novartis wants to be transparent so we can get a complete insight into where we are going right, what we are doing wrong, and what impact our programmes are having on healthcare. We need a clear overview of how well Novartis Access is doing and what we can do to improve it. Novartis has also set up an evaluation team to measure this success of the programme, right? Any challenges faced in setting up this evaluation? We discussed the evaluation methodology at length with Boston University and settled on an approach which not only looks at how well we use the program, but also how much of an impact it has on households and availability of medicines. Ultimately, the most important thing is for Novartis Access to work with credible outside evaluators – they must have complete independence in how they measure its impact and publish their results. How will Novartis Access add value to the efforts taken by the government to improve access to healthcare in India? At the moment, Arogya Parivar is our focus in India. Novartis Access is not something we have ruled out implement-
1. “Novartis launches 'Novartis Access', a portfolio of affordable medicines to treat chronic diseases in lower-income countries” novartis.com (24/09/15) 2. “Infectious diseases - Achieving extraordinary progress” - David Nabarro, davidnabarro.info (11/01/17) 3. “Remarkable progress made, but long way to go to beating infectious disease” - John Boozman, Devex (29/05/15) 4. “Noncommunicable diseases in developing countries: A symposium report” (Islam et al. 2014) 5. “Chronic disease to cost $47 trillion by 2030: WEF” - Kate Kelland, Reuters (18/09/11) 6. “Novartis invites scrutiny of effort to improve access to medicine” novartis.com (15/05/17) 7. http://www.afro.who.int/en/ rwanda/country-health-profile/ health-and-development.html 8.“Role of government in public health in India: Current scenario in India and future scope” (Lakshminarayanan 2011) 9. http://www.worldometers.info/ world-population/india-popula tion/ 10.http://www.worldometers.info/ world-population/ethiopia-population/ 11. http://www.worldometers.info/ world-population/kenya-population/ 12. http://www.worldometers.info/ world-population/rwanda-population/ 13. http://www.investopedia.com/ articles/investing/022415/worldstop-10-economies.asp 14. http://www.businesstoday.in/ current/economy-politics/indiahas-highest-number-of-people-living-below-poverty-line-worldbank/story/238085.html 15. https://ec.europa.eu/research/ health/pdf/hpforum/novartis_access-factsheet-january_2016.pdf 16. “Community health workers for noncommunicable diseases” (Neupane et al. 2014) raelene.kambli@expressindia.com
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‘We provide advance diabetes management ecosystem for our patients and doctors’ Dr Sanjiv Agarwal MD and Founder, Diabetacare, gives an overview of diabetes epidemic in India and how Diabetacare’s clinico-Technology solution has been able to efficiently monitor people living with diabetes, in an interaction with Mansha Gagneja Why is there a need to bridge the gaps in current diabetes management strategies and what are the challenges? About 70 million people live with diabetes in India and the World Health Organization (WHO) estimates that an additional 36 million remain ignorant of their condition. This means that nearly one in 10 Indians suffers from this condition but is either unaware of it or is slipping through the treatment cracks with inadequate reporting and monitoring. There is a definite problem with awareness of diabetes among people. Once they become aware, the second problem arises with the acceptance of the disease, at least for the first few years. Unless the patient accepts the condition, it becomes a challenge to manage/monitor it. How does clinico-technology assist in transforming diabetes management? Diabetacare’s clinico-Technology solution enables efficient close monitoring and management of people living with diabetes. The aim is to enhance patient care, enabling healthcare providers to asynchronously communicate with their patients in a technology-enabled, and high-touch model minimising risk of errors and improving clinical outcomes. Our diabetes management centre is a 24x7 clinical contact centre, staffed with doctors, diabetes specialist nurses and diabetes educators. This team supports patients, physicians and patient families in improving compliance and providing round the clock care for better outcomes. Which solutions do you offer? At Diabetacare, we understand
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that a physician’s concern for their patients goes beyond managing their blood glucose levels. We also know that diabetes management needs treatment and care options above and beyond basic consultations. To ensure that the physicians are best supported in providing their patients complete diabetes management solution, we have developed unique products and services that would complement their services and ensure 360-degree care. Diabetacare technology components include: DiabetaCart: This has been designed to provide comprehensive investigations focusing on Diabetes complications and consultation to improve lifestyle and compliance. DxNET: Comprehensive Diabetes Electronic Medical Record (EMR) system with intelligence built for clinical decision making (CDM), which provides prompts and nudges to the caregiver (physicians, diabetes specialist nurses, diabetes educators, super specialist physicians) and to the people suffering with diabetes. DIABETAPAD: Physician can access patient’s clinical trends; visualize the history & relevant sections of patient’s vitals & investigation in an easy to use electronic tablet & INTOUCH Physician app (in iOS & Android) dCare Smart: dCare Smart is a connected 'smart' glucometer. Results are transmitted within 30 seconds to DxNET. dCare 2-in-1: dCare 2-in-1 is a bluetooth-enabled glucometer and blood pressure monitoring device for patients at higher risk. DIABETA app: The Diabeta app acts as companion tool for
intake and helps control weight and blood sugar level. The app allows the physicians to stay up-to-date on their patient’s health and provide timely care. Diabetes Management Centre (DMC): Diabetes Management Centre (DMC) is a 24×7 contact centre which has been developed to provide assistance to people with diabetes. DMC team consists of diabetes specialist nurses (DSNs), diabetes educators, diabetes specialist nutritionists and health coaches who are trained by clinicians and accredited by UK universities.
At Diabetacare, we provide advance diabetes management ecosystem for our patients and doctors
Brief us about the diabetes management platforms available? We provide advance diabetes management ecosystem for our patients and doctors. This includes: ◗ Smart glucometers ◗ Electronic medical records with in-built clinical decision making based on NHS guidelines ◗ Diabetes management apps for patients and doctors ◗ 24x7 Diabetes Management Contact Centre
the patients for reminders and alerts (for checking BGL, BP, taking medication, doing exercise, tracking calorie intake). Patients and authorised family members can easily visualise the trends, reports, care plan in this easy to use interface. This is available for download on both iOS & Android platforms. InTouch Physician App: The InTouch Physician App helps you manage and monitor patients that require extra care and attention. Snap a Meal app: ‘Snap a Meal’ captures information on calorie
Are there any reports which show that diabetes can be managed effectively using these solutions? We have published several research papers to prove that diabetes can be managed effectively using these solutions ◗ Alerts with remote monitoring improves diabetes control and increases confidence ◗ Structured care plan improves metabolic control What is the mechanism of these solutions? Elaborate on the technologies which have
been incorporated? The solution is web-based application hosted on robust Linux-based platform and in highly reliable amazon infrastructure. The mobile applications are developed in native development platforms namely Java for Android and ObjectiveC/Swift for iOS to ensure great user experience and performance of the application. What are the new innovations in the pipeline? We are working on smarter decision making tools for our physicians and on algorithms which will prompt swift actions both from the care giver and care recipient. How accurate are these solutions? Quality assurance and accuracy of the solution is the top most priority of Diabetacare team. Diabetacare clinico-technology ecosystem which includes in-clinic diagnostic module and tools connecting to well-known brands, are either FDA approved or CE marked, helping our partners to efficiently screen diabetes complications in any given setting. Accuracy of these devices are well documented and undergo rigorous international scrutiny. Algorithms in our primary smart Electronic Medical Record System (DxNET) are based on International guidelines adopted from NICE (UK) or ADA (US) – these are continuously improved as the guidelines are updated. Diabetacare smart SIM enabled Glucometer (dCare Smart) is FDA approved as well as tested by NIH in India with highest level of accuracy for such devices. mansha.gagneja@expressindia.com
STRATEGY
Teaming up to thwart tobacco The Indian government has left no stone unturned in the fight against tobacco consumption. Rajasthan, Punjab and Uttar Pradesh have been successfull in this initiative. Mansha Gagneja unravels how various stakeholders join forces to tackle this menace
T
hey say that everything has its pros and cons. Well, it doesn't always hold true, at least not in the case of tobacco. The only legal drug in most parts of the world, tobacco is conquering all and siphoning life worldwide. In 2008, the World Health Organisation (WHO) named tobacco as the world's single greatest preventable cause of death. Globally, the regulating bodies are realising the need to curb this harmful substance and are devising various initiatives to control it. To address the global burden of tobacco, the World Health Assembly in 2003 unanimously adopted the World Health Organisation Framework Convention on Tobacco Control (WHO FCTC). In force since 2005, the main objective of the WHO FCTC is to protect present and future generations from the devastating health, social, environmental and economic consequences of tobacco consumption and exposure. Ratified by 180 Parties as of March 2015, the WHO FCTC currently covers about 90 per cent of the world's population.Though it seems unbelievable when one sees the current rate of tobacco consumption, it has significantly reduced. Comparing Global Adult Tobacco Survey (GATS) I (2009-10) and GATS II (2016-2017), it is derived that the prevalence of tobacco use in India has been cut down by six percentage points. The graph shows relative reduction of tobacco users from GATS I to GATS II India has come a long way in controlling the use of tobacco.There have been significant measures taken up by the Central government as control initiatives. The introduction of GST, imposing 28 per cent GST tax with an additional five per cent cess levied on branded ciga-
Source: MoH&FW
rettes, has been positive step taken by the government. These strategic measures are considered an effective means of reducing tobacco consumption and curtailing its demand. The Ministry of Health and Family Welfare (MoH&FW) has also launched the National
Tobacco Control Programme (NTCP) in 2007- 08 in 42 districts of 21 States/Union Territories of India. Under the programme, Tobacco Cessation Centres (TCC) were setup to provide counseling to tobacco users for quitting the tobacco addiction. Recently, Union
Minister of Health and Family Welfare conferred the WHO Director-General’s Special Recognition Award for global tobacco control. On the occasion JP Nadda, Health Minister, MoH&FW informed that the government has implemented large pack warnings
with 85 per cent pictorial health warnings on both the sides, strengthened cessation facilities with the launch of the toll-free National tobacco Quitline and mCessation services and have made substantial investment under the 12th Five Year Plan for expansion of
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STRATEGY NTCP. He further added that India has also put a ban on smokeless tobacco products and has strengthened the implementation of the tobacco free film and television policy. With an alarming 27 crore users, tobacco consumption in India is still second largest in the world. Although Central Government is putting in all the efforts, a collective endeavour by the State governments and NGOs will help repress the consumption.
State initiatives In 2003, The Cigarettes and Other Tobacco Products Act (COTPA) was introduced which dealt with prohibition of advertisement and regulation of production, supply distribution and trade and commerce of tobacco products. With this parliamentary act, WHO ushered member states to implement measures to provide non-smokers protection from involuntary exposure to tobacco smoke. Many initiatives have been taken up by individual states in collaboration with NGOs to impose regulations.
Rajasthan The Government of Rajasthan is working on NTCP, which is currently being implemented in all 34 districts of the State. A state level coordination committee has been constituted in order to ensure that coordinated efforts are made by all key departments including Home, Medical & Health, Finance, Agriculture, Rural Development, Panchayati Raj, Law, Education, Forest & Environment. Various campaigns have been initiated which aim at deterring the demand, creating awareness and assisting to quit. Dr Rakesh Gupta, President, Rajasthan Cancer Foundation has stated that the state levies highest tax of 65 per cent on all tobacco products which will discourage the demand. In February, 2017 a campaign was carried out all over the State in which marathon race/ rallies were held in all blocks & districts to create awareness and a total of 1.78 lakh challan were made in a single day. This largest mass mobilisation campaign was recorded in World Records India. Separate income head for depositing the challan money collected has been created by the state gov-
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ernment. Total 1.99 lakh challan were made and ` 28.04 lakh was collected in 2016-17. Tobacco cessation centres are also made operational in 16 districts in which 12,282 tobacco users were counselled during 2016-17. Besides this, toll free Quitline (PAHAL) was made operational through 104 (medical advice service) and 108 (emergency helpline) for providing cessation help to tobacco users wishing to quit. Naveen Jain, Mission Director, National Health Mission (NHM), stated that funding for these programmes comes from the state government and pointed out that the NGOs can get access to the state funding to initiates control drives. Dr SN Dholpuria, State Nodal Officer, Tobacco Control Programme informed about another drive which includes charging penalties for public smoking and Rajasthan has fined 2.38 lakh violators which is maximum for any state across India..
ill effects of tobacco through posters, audio and video clips. Dr Rakesh K Gupta, Mission Director, NHM, revealed that the state of Punjab has lowest prevalence of tobacco use in country. Tobacco use among men has declined from 33.8 per cent (NFHS-3) to 19.2 per cent (NFHS-4) and in women from 0.8 per cent to 0.1 per cent during last 10 years, which is lowest among all the states of the country. Tobacco Control Cell, Punjab is now aiming to put an end to tobacco by further reducing prevalence of tobacco use to five per cent by year 2025. In regards to the policy of no smoking in public, 26,909 people were penalised in year 201617 and 5,087 April-May 2017. The state also observes a ‘Punjab State No Tobacco Day’ which is celebrated on November 1, with different theme each year.
Uttar Pradesh Punjab Under COTPA, all 22 districts of Punjab have been declared as tobacco smoke free districts on the basis of compliance study by PGI Chandigarh. Various campaigns have been executed at all levels- state, district and village. A month long ‘World No Tobacco Day’ campaign was launched flagging off the publicity van that visited more than 110 towns of all the districts of Punjab and also covered more than 250 schools to create awareness among the people, especially the youth, about the
An alarming
27
crore
people consume tobacco in India,which is second in the world
In Uttar Pradesh, NTCP has been implemented in 75 districts. Satish Tripathi, State Consultant, NTCP gave details on the various enforcement activities active in the state, one of which includes state’s association with selected 70 NGOs. These NGOs will cater to 70 schools each (approx 10 lakh
Imposing
28 5
% GSTtax with an additional %cess levied on BRANDED CIGARETTES,has been a positive step taken by the government
students) to create awareness about the ill-effects of tobacco in an year. To further reduce the consumption of tobacco, he shed light on the ban on loose cigarettes. There have been cessation centres set up in 72 districts to help people quit tobacco consumption and the state will urge more officers to counsel against tobacco.
NGOs and organisations: Different stakeholders are collaborating with the state and Central Government in order to weed out tobacco. The government is driving these initiatives through prominent NGOs and organisations including hospitals and cancer institutes. For instance, training programmes in Rajasthan are run by Rajasthan Cancer Foundation in various districts for capacity building. Under this programme four people are appointed, namely district tobacco control consultant, counsellor, social worker and a data manager. These doctors, once trained, will create awareness among tobacco users, about treatment options available and to empower subordinate staff. Another drive 'Coalition Against Tobacco' is a representative body formed by the collaboration of more than 40 NGOs which hold the view of taking a proactive stance of nipping the trouble of tobacco in the bud. The coalition has written an open letter to Narendra Modi, Prime Minister, India, on the occasion of World Environment Day elucidating the negative en-
CENTRAL GOVERNMENT INITIATIVE
In 2003,The Cigarettes and Other Tobacco Products Act (COTPA) was introduced
vironmental impacts of cultivation and processing of tobacco.
Recommendations Despite immense effort being put up collectively, there still remain a lot of hurdles to be overcome. Multiple challenges need to be turned around in order to create a tobacco less environment and curb NCDs caused by tobacco. Jain highlighted the revenue involved as a major obstacle to imposing a higher tax. And even though the government is imposing high tax in some states, many other face the resistance from tobacco lobbies and are helpless. There is a need for measures to be taken to handle these activities. A few measures have been taken up internationally for instance, Bloomberg & Bill Gates launched the AntiTobacco Trade Litigation Fund, which is a joint effort to combat the tobacco industry’s use of international trade agreements to threaten and prevent countries from passing strong tobaccocontrol laws. India has also signed a treaty with WHO which states that Government of India will not interact with tobacco industry. If at all it is necessary, it will interact in a transparent manner. This has to be efficiently implemented to reduce the stronghold of tobacco players. Deepak Misra, Executive Director, Socio Economic and Educational Development Society (SEEDS), an NGO involved in creating awareness on the ill-effects of tobacco consumption, suggested that the supervision of training programmes along with the drives conducted should be improved. He added that recruitments drives should be carried out against the positions available in NTCP to increase the workforce. Dr Gupta, NHM also mentioned the fact that taxes on tobacco products in India fall way below the rate recommended by the World Bank, which is 65 per cent to 80 per cent of retail price. The tobacco epidemic is devastating– but preventable and the fight against tobacco must be engaged forcefully and quickly. Going forward, the government might consider these recommendations in accordance to bringing an end to tobacco manufacturing as well as consumption. mansha.gagneja@expressindia.com
STRATEGY I N T E R V I E W
Our focus in India has been to create a national healthcare data repository SearchLight Health, a Bengaluru-based subsidiary of Piramal Enterprises Limited (PEL) is transforming healthcare in India by data analytics. Madhu Aravind, CEO, Searchlight Health, share more details about the company’s offerings for healthcare, in an exclusive interaction with Lakshmipriya Nair How is analytics impacting healthcare, globally and in India? Copious amounts of healthcare data is generated daily by various stakeholders in the healthcare ecosystem like hospitals, clinics, pharma companies, insurance companies, drug stores, diagnosis centres, etc. as part of their business operations. Healthcare analytics enables this data to be scientifically analysed to create technology solutions that improve clinical outcomes, operational efficiency, healthcare financing, etc. It benefits both the healthcare industry as well as patients. How does Searchlight Health’s offerings provide data science driven predictive and prescriptive analytics? We are working with the simple premise that healthcare in India can be transformed by data analytics. Examples of these can be the ability for insurers to launch personalised products to drastically improve access, doctors to see previously unseen patterns in care delivery, pharma companies to understand health drivers and large scale real world usage information, etc. We believe that by bringing together anonymised patient data, leveraging data that is publicly available and by building best-in-class analyt-
The field of health data analytics is one whose time has come and will create immense value to the entire ecosystem in the next decade. ics solutions, healthcare in this country can be more accessible and create more impact with available resources. How can the healthcare industry leverage big data and analytics to increase and drive their R&D efforts? For hospitals, healthcare analytics can impact multiple ar-
eas from customer acquisition to operational efficiency to clinical delivery. It can be the backbone of marketing teams to target and retain the right type of customers, help operations teams understand where the hospital truly excels in and where it needs to work on to achieve high-cost efficiencies. Unlike many software prod-
ucts that are essentially just data repositories and workflow managers, data analytics can enable a doctor to create a better outcome for the patient. Traditionally, most medical principles have been based on observations from a few hundred to a thousand people. The advent of digitisation, abundant computing power and new age machine learning models, will enable the formulation of principles from observations from millions of people, creating the foundation for personalised medicine. For insurers, there is a significant opportunity to leverage the power of data analytics to increase the coverage of middle class from the current five per cent to 50 per cent. Using the power of data analytics solutions, insurers will be able to understand disease propensity in detail and also fully model the cost of care needed to manage various conditions. This will enable the creation of insurance products that have a range of customisable features catering to the diverse needs of people, from those who need a ‘nano policy’ to those who need a ‘BMW policy’ based on their preferences! For the pharma sector, even though India is currently a generics market, there is immense potential to fundamentally rethink how real world evidence can power R&D, clinical trials, etc.
Can you elaborate on the cost advantages that could be generated annually through adoption of data analytics by hospitals and health insurers? There are two ways in which data analytics can create cost advantages. First is by leveraging administrative solutions to be more efficient with same resources and second is to create higher quality products/services without proportionately increasing cost. For hospitals, this means that their marketing, operations programmes can create better output with their current budgets and clinical solutions can improve outcomes. For insurers, data analytics enables them to not only increase their customer base with products that have broader appeal, but can also increase efficiency in the areas of fraud management, claims processing, etc. There are reports which reveal that investments made in analytics are yet to see substantial benefits. What is your take on this issue? To what extent is it deterring the adoption of data analytics in the healthcare industry? What are the other challenges hindering the adoption of data analytics in the healthcare industry? Traditionally, for most organisations data analytics meant
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STRATEGY purchasing a business intelligence tool and creating reports. The impact of such tools was minimal as most healthcare data is both nonstandard and unstructured (text, images) and data from multiple sources had to be combined to create value. With the progress made in Natural Language Processing, image recognition and speech analysis combined with the availability of large-scale computing power, the ability to convert this type of information into analysable signals is now within reach. This enables such solutions to create disruptive value both in terms of quality cost and access. While data analytics holds a lot of promise, it also faces some challenges in the Indian ecosystem. Firstly, the talent needed in organisations to leverage data analytics is in limited supply. So any analytical solution needs to account for this and have a truly worldclass usability for business users and offer shrinkwrapped solutions that demand little by way of deployment efforts. Secondly, most healthcare organisations including hospitals spend less
While Piramal’s global analytics business have 250+ people in India, Searchlight team has a team of 50+ purely focussed on the India business. By the end of 2020, our goal is to partner with 1000 hospitals in the country than one per cent of their budget on software technologies as they have not seen serious business value generated from such initiatives in the past. This will slowly get reversed as they start seeing tangible value. As in any nascent industry, adoption will be gradual, beginning with early adopters and then to mass market. But, there is no doubt that the field of health data analytics is one whose time has come and will create immense value to the entire ecosystem in the next decade. What are the factors which will drive the future IT applications in healthcare?
How is Searchlight Health poised to drive these trends and leverage the growth potential and opportunities that would arise in India? Most enterprise applications in healthcare focussed more on workflow automations, data capture, etc. and did not really make a 10x improvement for its users like doctors, nurses, etc. With the advent of commercialisable AI, cheap cloud computing infrastructure, applications can truly focus on creating disproportionate value to the end user. Our focus in India has been to create a national healthcare data repository, which combined with India-specific AI-driven
applications, can enable Indians to avail quality healthcare using affordable financing models. Since our group companies have been into this business for 20+ years and work with nearly all of the top life sciences companies worldwide, we also have the right type of experience combined with best of class processes, technologies needed to make this happen. What is the scope of operations for Searchlight currently? What is the midterm and long-term strategy for Searchlight? We started our operations around two years ago in Bengaluru. We have signed up over 100 hospitals across Bengaluru, Hyderabad, Delhi and Chennai. While Piramal’s global analytics business have 250+ people in India, Searchlight team has a team of 50+ purely focussed on the India business. By the end of 2020, our goal is to partner with 1000 hospitals in the country. Why did Piramal Group invest in Searchlight Health? What is the value-add that Piramal got by acquiring
Searchlight? Piramal Enterprises Limited (PEL) took control of Searchlight Health, as part of our larger Information Management initiative. Much like our acquisition of the Decision Resources Group, our investment in Searchlight Health was based on our belief that the use of data and analytics will be critical in the successful evolution of the global healthcare system over the next decade. We believe that Indian healthcare can be transformed by fundamental insight into cost, access, quality and utilisation of healthcare resources. Searchlight Health brings together disparate public and private data to create products that help increase business penetration, provide critical decision support, optimise clinical and operational processes. Searchlight Health brings technology and engineering skills to PEL and Decision Resources Group (DRG), while PEL and DRG’s relationships across the Indian and global healthcare ecosystems are helping Searchlight Health achieve its strategic objectives. lakshmipriya.nair@expressindia.com
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photograph, preferably in colour, high resolution with a good contrast. Email your contribution to: viveka.r@expressindia.com Editor, Express Healthcare
RADIOLOGY INSIGHT
RADIOLOGY: PAST, PRESENT AND FUTURE Dr Deepak Patkar, Consultant Radiologist and HOD Radiology — Nanavati Super Speciality Hospital, details how radiology has evolved across the decades to emerge as a key diagnostic and therapeutic tool in healthcare delivery
R
adiology since its origin as a medical speciality has been a keystone in healthcare. It is probably one of the most rapidly advancing branches in medicine. As we all know, to start treatment for any ailment the first thing needed is correct diagnosis and no one can imagine diagnosing diseases without radiologic investigations. Earlier, physicians had to rely on their clinical knowledge and skills to diagnose diseases, which was mainly based on imagination like they used to suspect that a patient with right lower abdomen pain could have acute appendicitis but now we can actually see and pick up diseases. Medicine with radiology has moved from imagination to imaging and now we are in an era where technology is even beyond imagination. Technology has progressed by leaps and bounds, pushing the boundaries of imaging for the benefit of mankind. Radiology has moved from conventional analogue systems to digital image acquisition modalities. Direct radiography systems, to start with, allow improved image quality and/or dose reduction. With amor-
phous Selenium coated flat panel thin film transistor (TFT) array technology, there is improvement of the workflow due to shorter preview times and therefore a higher thoroughput of patients. Ultrasound is a perfect combination of effective, sensitive and non invasive, free of radiation, bedside, portable as well as patient friendly imaging technique. The high end scanning systems enable us to do real time 3D and 4D scans. None of the other modalities compare with USG in terms of antenatal scans. Colour doppler evaluations are a part and parcel of vascular medicine. Computed tomography (CT) is an essential tool in diagnostic imaging for evaluating many clinical conditions. In recent years, there have been several notable advances in CT technology that already have had or are expected to have significant clinical impact, including extreme multidetector CT, iterative reconstruction algorithms, dual-energy CT, conebeam CT, portable CT, and phase-contrast CT. The net effect of all these advances is higher spatial and temporal resolution. This allows faster
acquisition of high quality images. Examinations like angiography has emerged as a highly efficient diagnostic alternative to conventional catheter angiography, significantly reducing the examination time and precluding the risks associated with catheter angiography. With newer reconstruction algorithms like iterative reconstruction, there is significant dose reduction to the patients. Technology like DECT has enabled gallstone and renal stone characterisation, differentiating gout from pseudogout, metal artifact reduction, myocardial iron detection, etc. Magnetic resonance imaging (MRI) has been playing an increasingly important role in biomedical research and in clinical diagnosis. There have been several advances in the MRI hardware and software which has enabled faster acquisition of high resolution images. Other advances include functional MRI (fMRI) of the brain which detects neuronal activation in the brain based on local increase in the oxygen-enriched blood in capillaries associated with the signal change measured in traditional BOLD MRI tech-
nique. Diffusion tensor imaging (DTI) is another interesting, advanced MRI technique which can depict neuronal tract projections in the brain and spine and the effect of various pathologies on these neurons. Arterial spin labelling is a non-invasive MRI perfusion technique which allows assessement of alterations in the blood flow in the the brain in various pathological states. For example; in a treated case of brain tumour there will hyperperfusion in case of residual disease or recurrence vis-àvis post treatment changes, which would be hypoperfused. MR guidance can also be used for biopsy of soft tissue pathologies affecting organs like breast, prostate etc. Now, we not only deal with diagnostic radiology but also therapeutic radiology. Vascular and non-vascular interventions, guided procedures and techniques like MR guided high frequency ultrasound for treating fibroids, bone tumours etc. provide effective minimally invasive treatment to patients. A challenge specific to the field of radiology is its fast pace of advancement which necessi-
DR DEEPAK PATKAR Consultant Radiologist and HOD Radiology — Nanavati Super Speciality Hospital
tates every radiologist to keep him/her self up to date. A person trained around 20 years back might have not been trained in many of the techniques in use today, many of the things might have become simply obsolete. In this scenario, we specifically need an organisation which can provide a platform to bring these updates to the reach of each and every practising radiologist. Another problem streaming out of the same fact is that the latest technology is available only to a small strata of students who are getting trained in big corporate hospitals or tertiary level medical colleges in major cities. The ongoing CMEs and conferences are really a help. Digital media is a wonderful tool as we can always find reference materials in text and audiovisual format to upgrade our knowledge and keep ourself upto date. We, as radiologists, have a special benefits of teleradiology wherein an expert from say Mumbai or Delhi can report for hundreds of villages and townships from across the country. We need to support and encourage such teleradiology networks and organisations. At the same time, national level organisations should take efforts to set a benchmark for their basic standards. The final goal would be that each and every town in this country have their own qualified and competent radiologist. Successful practise of modern day medicine needs true integration of medical skills, technology and management proficiencies. Our aim should always be to provide our patients with best possible level of care and treatment. One thing to remember is that learning is an ongoing process and with medicine its a never ending process. Future is yet to see much more and one should be ready to keep pace with these advances.
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TRADE AND TRENDS
SCHILLER launches DIAGNOSTIC STATION DS20 In addition to physician offices, retirement homes, hospitals and clinics, the DS20 is a useful tool for routine check-ups in occupational medicine
SCHILLER’s DS20 is self-explanatory and very little training is needed. The large interactive touch screen supports the highest user-friendliness.
SCHILLER HAS launched DIAGNOSTIC STATION DS20, the most comprehensive diagnostic station with unique features: resting ECG, PWA, and Spirometry. It is designed for spot measurements and routine check-ups of non-critical patients. In addition to physician offices, retirement homes, hospitals and clinics, the DS20 is a useful tool for routine checkups in occupational medicine. DS20 enables physicians to perform tasks in five minutes with one device which may otherwise take 20 minutes with multiple devices. It is an ideal tool for patient induction process in a hospital, as the patient’s vital parameters are quickly checked on a single platform and the data can be automatically transferred and stored to the hospital information system
One touch to the measurement
through HL7 protocols. One of its important features, the advanced Pulse Wave Analysis (PWA) helps in easier understanding of hemodynamic and the process of arterial aging within minutes with graphical indication, which is useful in screening patients for early evidence of vascular disease and monitoring the response to the therapy given.
Simply touch the large, high-resolution colour display and you are in the business recording, and selecting the highest quality ECGs. ◗ Perform ◗ Review ◗ Store or export wherever you want
Connected DS20 simplifies daily work ◗ Main vital signs and physical assessment tools united in one device ◗ Ideal for arrhythmia and atrial fibrillation screening: one resting rhythm channel for display, storage and printing with three electrodes ◗ Large, interactive touch screen ◗ Intuitive guidance and ease of use
Fast and easy to use The DS20 immediately detects connected sensors and automatically displays the corresponding value. This fast operation allows for easy addition or removal of parameters. Thanks to its intuitive user guidance
The DIAGNOSTIC STATION DS20 is a networked device. Seamless connectivity to EMR, PACS, HIS or SCHILLER’s SEMA3 Cardiology Information System is possible and bidirectional communication allows for easy data access, while Wi-Fi with strong security enables direct and fast transmission.
Expandable Easily add new functions and other devices or future technological developments. The DS20 is ready for the most common functions and will satisfy new requirements. ◗ DS20 on trolley - easy transport between rooms ◗ DS20 on wall mount - saves space ◗ One-time patient data entry saves time and reduces data errors ◗ Large display (18.5”) - all information at a glance, no submenus ◗ Touchscreen and intuitive icons - one touch to measurement ◗ Interface to scales - automatic weight, height and BMI measurements Contact details V Balakrishnan Phone:022 61523333 Email: bala@schillerindia.com/ media@schillerindia.com Website: www.schillerindia.com
Medical devices sector on growth league in India Vivek Tiwari, Founder and CEO, Medikabazaar, elaborates on how government measures along with certain reforms can transform the medical devices market in India WITH THE Make in India initiative all set to progress, India is looking forward to tremendous growth opportunities in nearly all industries including the healthcare sector. Development trends over the last decade indicate even greater potential in the coming years. Conducive policies for encouraging FDI, joint ventures, tax benefits have influenced the Indian market. The Indian healthcare industry is already expecting a huge growth, almost up to $280 billion by 2025. One of the high growth potential markets within this industry is the medical devices segment. The medical devices segment in India was evaluated
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at around $6.3 billion in 2013, contributing only around 7-8 per cent of the total healthcare market in India. However, it is expecting an unprecedented growth of around $50 billion by 2025 increasing its contribution to almost 17-18 per cent. India is a fast growing market for medical devices. Based on the figures, the medical devices segment is recording a compound annual growth rate of 21 per cent. The government is actively taking into consideration several reforms to develop the market by regulating the unorganised medical supplies market and bringing transparency in the industry. It has already approved
VIVEK TIWARI, Founder and CEO, Medikabazaar
100 per cent FDI allowance in medical devices which will change the outlook of the industry for the better. The absence of a consistent and organised framework and lack of initiatives and funding in the past did not allow the medical devices sector to flourish to its full potential. However, the changes in FDI policy will definitely go a long way to improve the medical devices sector, but there are a bunch of other barriers that could hinder foreign in-
vestors from manufacturing and investing in India. High tax rates imposed on domestic manufacturers as compared to the low amount of taxes levied on imported medical supplies seems unappealing to foreign investors. It is one of the key reasons why foreign firms choose to access India’s medical market without establishing their direct presence and instead set up their manufacturing units in neighbouring countries and export these devices into India. Regardless of the challenges that India faces, it offers numerous advantages such as low labour cost, high level of technical expertise, funding aids from governments to boost the development of the medical devices sector in India. These benefits have made India one of the most recommended destinations for outsourcing the manufacturing services of medical supplies. With constantly
changing technology, more and more multinational as well as domestic manufacturers are looking at modifying and customising their products based on specific requirements of different countries. Keeping this in mind, one can easily comment that the medical devices segment is only likely to grow in the coming years. India is termed as the world’s capital of coronary heart disease and diabetes. Apart from this, factors like growing population, change in the disposable income, increasing diseases and growing awareness among people to focus on health, attribute to the growth of medical devices industry in India. Availability of low-cost production of medical devices coupled with international quality standards marks the evolution of India as the most attractive production hub for leading medical devices manufacturers.
TRADE AND TRENDS
Zebra boosts healthcare portfolio with newvisibility solutions and partnership with GE Healthcare New DS8100-HC series scanners and TC51-HC mobile computer provides improved workflows for healthcare professionals and better patient experiences ZEBRA TECHNOLOGIES Corporation, the market leader in rugged mobile computers, barcode scanners and barcode printers enhanced with software and services to enable real-time enterprise visibility, is introducing two new purposebuilt mobile handheld devices that will improve clinical mobility workflows and patient care. The DS8100-HC series scanners and the durable TC51-HC mobile computer can foster clinical collaboration for staffers and drive better operational efficiencies, while also supporting the five rights of medication administration to help increase patient safety. The new products expand Zebra’s portfolio of healthcare solutions. In addition, Zebra recently partnered with GE Healthcare to bring Bluetooth Low Energy (BLE) wireless asset tracking technology to hospitals. GE Healthcare’s Encompass is a cost-effective real-time location systems (RTLS) solution that
helps hospitals manage mobile asset inventory, reduce total cost of ownership (TCO) and achieve better capital allocation.
Key facts ◗ Both the DS8100-HC series and the TC51-HC mobile computer can capture virtually any barcode in any condition and scan the most problematic barcodes found in pharmacies, labs, and at the point of care to help improve productivity and efficiency. ◗ The DS8100-HC sseries imager, available in corded (DS8108-HC) and cordless (DS8178-HC) versions, features a purpose-built housing using special plastics that prevent the spread of bacteria and allow for safe wipe-downs with a wide selection of strong disinfectants used in hospitals. ◗ The DS8100-HC sseries comes with a wide selection of feedback modes such as standard LED, vibrate, and beeper feedback, instantly notifying
healthcare workers when a barcode is properly captured without disturbing the patients. The Android-enabled TC51HC mobile computer can perform multiple tasks, such as calling/texting co-workers, receiving calls via PBX, accessing patient records, scanning barcodes and increasing medication administration accuracy. By consolidating these applications into one device, tasks can be executed with ease and proficiency. An ultra-high resolution, rear-facing camera and a frontfacing camera enable healthcare professionals using the TC51-HC to provide an intricate account of patient condition and offer remote consultation for quicker service. The TC51-HC is supported by LifeGuard for Android, Zebra’s software security solution that extends the lifecycle of Zebra Android enterprise mobile computers. LifeGuard adds years of operating system (OS) security support – beyond the
consumer support timeline – to match the enterprise hardware lifecycle, helping organisations significantly lower TCO while ensuring the most updated security. Zebra’s Workforce Connect: PTT Express solution comes pre-installed and pre-licensed on the TC51-HC, providing clinicians with a push-totalk (PTT) option right out of the box with any PTT Expressenabled Zebra mobile computer, providing better collaboration and communication between healthcare workers. An integrated healthcare dictionary also enables autofill and suggestions for quicker, more accurate data entry. Wayne Harper, Senior Technical Director, Zebra Technologies Asia Pacific said, “We have seen digital healthcare increasingly take over the traditional ways of delivering patient care in Asia Pacific. Hospitals are adopting enterprise-grade mobile devices like the TC51-HC mobile computer and DS8100-
HC series scanners to record, cross-check, and analyse patient data. This has delivered tangible productivity and efficiency gains, reduced human errors, and significantly enhanced the patient experience. We foresee administrative work to be increasingly done using mobile devices, freeing up doctors and nurses for more valueadded tasks – ultimately enhancing patient care.” Chris Sullivan, Global Healthcare Practice Lead, Zebra Technologies said, “Zebra is pleased to collaborate with GE Healthcare as we see transformative value from this innovative, practical, and easy-to-implement real-time tracking solution. With Enterprise Asset Intelligence built by real-time visibility, clinicians now have reduced operational distractions and a greater ability to maximise their focus on patient care. This is a good thing for all of us and contributes to a higher-quality, lower-cost patient care environment.”
CurveBeam in collaboration with Carestream Health To promote weight-bearing CT awareness and research MEDICAL DEVICES companies CurveBeam and Carestream Health announced a collaboration to support and facilitate education and research for weight-bearing computed tomography imaging. “The ability to capture weight-bearing CT images allows foot and ankle specialists to study foot biomechanics in three dimensions. Significant clinical research has already demonstrated weight-bearing CT has the potential to be the new standard of care for an initial diagnosis. However, much work remains to be done to increase awareness among orthopaedic specialists,” said Vinti Singh, Marketing Manager, CurveBeam. “Through collaboration, CurveBeam and Carestream can best support
these efforts.” Before the introduction of weightbearing CT imaging in 2012, patients could get either a weight-bearing radiographic 2D X-ray or a non-weight bearing medical CT scan. X-rays can at times obscure and distort anatomical details, while non-weight bearing CT scans may inaccurately represent joint space and alignment. The American Orthopaedic Foot & Ankle Society recommends weight-bearing imaging when possible to get the most accurate assessment. “The image quality and detail captured with 3D weight-bearing CT exams allow the surgeon to view and measure anatomical abnormalities of lower extremities under natural load conditions,” said Helen Titus, Carestream’s
Worldwide Marketing Director for Ultrasound & CT. “The goal of this collaboration is to spread the word about this new imaging modality among orthopaedic specialists.” The companies will work together to support the Weight-Bearing CT International Study Group, which consists of orthopaedic researchers from leading institutions in the US and Europe. The group is working to create standardised protocols for weight-bearing CT measurements and analysis. Both companies offer weight-bearing solutions for extremity CT imaging. The devices employ cone beam CT technology and are designed for point-of-care settings, as well as hospitals and imaging centres.
Contact details Nilesh Dattatray Sanap Carestream Health India 022- 67248816 nilesh.sanap@carestream.com
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TRADE AND TRENDS
Transasia showcases holistic approach for clinical diagnostics at APPI 2017 Over 1,000 practicing pathologists from India and across the globe participates during the three-day event THE 4TH ANNUAL Conference of APPI - Mumbai was recently held in Mumbai. Transasia BioMedicals was the principal partner. The annual conference hosted by the Association of Practicing Pathologists of India (APPI) was a conglomeration of industry experts from across the country. Over 1,000 practicing pathologists from India and across the globe participated during the three-day event. With a vision of being committed to a healthier and happier world, Transasia Bio-Medicals has been associated with APPI right since its inception. This year, Transasia has taken its participation to a whole new level in line with the introduction of new products and processes that provide an end-to-end solu-
tion for improved lab efficiency. Sysmex XN-330, the latest six part differential haematology analyser will be formally introduced at the event. This will be beneficial to laboratories as it offers the latest technology at an affordable cost. Transasia is the sole provider of Sysmex instruments in India and with XN-330, it endeavours to provide quality solutions that are cost effective. In addition, Transasia will be showcasing its number one selling product- EM 200, a fully automated biochemistry analyser. With over 2000 installations PAN India, EM 200 is the preferred choice for small, mid and chain laboratories and reaches out to over six crore patients. Transasia’s latest addition to the coagulation family, ECL 760 will
also be showcased at the event. Besides, Transasia is also organising interactive scientific sessions and workshops led by experienced industry veterans in haematology, biochemistry and coagulation. This will provide an important forum for practicing pathologists and lab owners to engage in a dialogue about critical compliance and operational challenges. This will also open doors for further discussions on the best practice approaches for addressing those challenges. Dr Barnali Das, ConsultantBiochemistry & Immunology, Kokilaben Dhirubhai Ambani Hospital, Mumbai conducted a workshop on ‘Lean Six SigmaHow to cut the extra flab from your lab platter.’ The workshop
encompassed adoption of verification/validation protocol and Lean-Six Sigma to reduce errors and improve the lab efficiency. It proved to be beneficial to laboratories as Lean SixSigma system can help labs achieve a number of objectivesreduce time traps, eliminate non-value-added steps, focus on the value added steps, and reduce complexity in the workflow process. Dr Das who holds a Green Belt in Six Sigma has already conducted this workshop as American Association of Clinical Chemistry (AACC) University’s short course in 2015 and 2016. Infact the course was identified as the Best AACC course to be circulated in the Middle East and other countries.
Transasia hosted a session on Middleware by S Parthasarthy, CEO, CareData. This focussed on cloud-base lab management system that efficiently scale up lab operations, improve TAT and help provide clinically accurate reports on time. Day three of the conference witnessed a motivational session on ‘A meaningful, fulfilled life’ by Dr RK Anand, Emeritus Director, Dept of Paediatrics, Jaslok Hospital, Mumbai. Dr (Col) Jyoti Kotwal, Sr Consultant- Haematology & Clinical Pathology, Sir Gangaram Hospital addressed the gathering on 'Futuristic Trends in Haematology.' The focus of the workshop was to introduce new trends to the haematologists.
Growth opportunities for urinalysis testing market Harshad Bhanushali, Product Manager- Instruments, DiaSys Diagnostics India, chalks down the reasons, which will drive the demand of urinalysis testing market in India URINALYSIS TESTING is used as the frontline diagnostic tool in the diagnosis of various metabolic abnormalities and UTIs. Urinalysis is also used as a disease management tool for the treatment of chronic diseases such as diabetes, Chronic Kidney Disease (CKD) and urinary bladder cancer. Rising kidney diseases owing to change in food consumption habits accompanied by growing concerns from geriatric population are among the major industry drivers. The World Health Organization (WHO) predicts that by 2020, chronic diseases will account for about three-fourths of all deaths across the globe. As urinalysis plays an integral role in the diagnosis of such diseases, the urinalysis market is
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expected to grow significantly in the near future. The growing prevalence of these target diseases and introduction of technologically advanced, rapid, non-invasive and user-friendly tools for urinalysis are estimated to be the major growth drivers of this market. Asia Pacific urinalysis market share is expected to witness a growth of over seven per cent CAGR up to 2023, mainly due to demand across India and China. Increase in advanced urine analysers adoption coupled with large number of untapped population is forecast to present attractive growth opportunities. The urinalysis market is broadly classified into product type, test type, applications, end user and region. On the basis of
HARSHAD BHANUSHALI, Product Manager- Instruments, DiaSys Diagnostics India
product type, it is subdivided into consumables and instruments. The consumables segment accounts for the largest share of the global market. Key reasons to influence demand of consumables segment leading to
global revenue is, increasing test strips and reagents usage due self-awareness. Dipstick, disposables and reagents are the major consumables in the industry. The major end users of urinalysis systems include hospitals and clinics, research laboratories and institutes, diagnostic laboratories, and home care settings. Clinical laboratories are the dominant segment and account for around 35 per cent of the global share. Growing concerns pertaining to hygiene and cleanliness accompanied by increase in number of hospitals and healthcare centres should positively drive the demand. Based on applications, the global urinalysis market is segmented into disease diagnostics and pregnancy tests. The dis-
ease diagnosis application segment is projected to witness the highest CAGR in the coming years due to factors such as increasing research for the development of new urinalysis tests for better, early diagnosis of chronic diseases and increasing incidences of chronic diseases. DiaSys Diagnostic India offers QDx Urinalysis solutions: QDx Urine strips (DS 10, DS 11 MAU, DS ACR) gives reliable results, high free from ascorbic acid interference, high sensitivity for all parameters and urine analysers (DS 100, DS 500), which are versatile and suitable for 10 & 11 parameter strip and convenient for the customer for use. Contact details: www.diasys.in
TRADE AND TRENDS
VihaWAVE Radial Shockwave Therapy – Non invasive, low cost and powerful Applications are associated with treatment of chronic muscular and tendon disorders etc RADIAL SHOCKWAVE Therapy is a non-invasive, low cost, unique and powerful solution for musculoskeletal pain. This radial shockwave therapy is frequently used in physiotherapy, orthopaedics and sports medicine. Applications are mostly associated with treatment of chronic muscular and tendon disorders, back and cervical pain. It results in faster pain relief and mobility restoration.
Power Levels / Energy Energy levels from 60 to 185 mJ adjustable precisely in steps of 10 mJ Pulse Frequency Frequencies from 1 to 22 Hz
Feature and benefits
No surgery – No pain killers VihaWAVE Shockwave Therapy is so effective that it removes the need for surgery and there is no need for pain killers. This makes it ideal to speed up recovery and cure indications causing acute or chronic pain.
Modern technology VihaWAVE Shockwave therapy has user-friendly interface. It has large intuitive and clear LCD Display with colour Touch Screen Design.
How it works? VihaWAVE shockwave therapy works on electromagnetic field principle. Electromagnets in the applicator accelerate a heavy projectile.
Principle A heavy, electromagnetically accelerated, ballistic projectile transfers its kinetic energy to a transmitter head in the applicator. The kinetic energy is transformed into impact energy in the applicator head. Shockwaves result and spread out radially from the contact area into the desired treatment region of the body. The projectile hits the applicator and creates a unique radial wave which is penetrating the tissue.
Treatment encyclopedia With preset protocols:
Mobility Complete system with require accessories fits into an easily carried aluminium case, making it portable.
Most common applications ◗ Insertion Tendinopathy ◗ Tendon problems ◗ Chronic inflammation ◗ Myofascial syndromes ◗ Status post Muscular Injury ◗ Trochanteric Bursitis ◗ Radial and Ulnar Epicondylitis ◗ Achillodynia ◗ Plantar Fasciltis ◗ Heel Spur ◗ Dupuytren's Disease ◗ Thumb Basal joint Arthritis
◗ Ergonomically designed ◗ Ballistic high energy pulses ◗ Foot switch operation for ease of treatment ◗ Just three to five treatments at weekly intervals with sessions that lasts for about 10 minutes ◗ Energy - 60 to 185mJ (1-5 bar) ◗ Pulse Frequencies from 1 22 Hz ◗ Cost effective ◗ Fast and long lasting effect
Technical specifications Technology Compressor free ballistic radial shockwave therapysystem with electromagnetic generator as projectile accelerator
VIHAWAVE VS COMPRESSED AIR SWT UNITS VihaWAVE Shockwave Therapy Unit
Compressed Air Shockwave Therapy Units
Principle
Electromagnetic field
Pneumatic compressed air
Weight
2.7 Kg, Light Weight
> 30 kg, Heavy Weight
Generation of energy
5 times heavy projectile
Light projectile, fast acceleration
More Comfortable Less Wearout
Less tolerable faster wearout
Lower Maintenance Cost
High maintenance cost due to pneumatic components
Maintenance
Mode 1 Continuous Mode 3 Burst modes (4 / 8 / 12 pulses) Adjustable Preset Programs Memory Card Slot SD-card slot available to store patient records Dimensions 200 x 350 x 300 mm Weight 3-4 kg (without applicator) Shockwave Applicator ◗ Ergonomic design with inbuilt fan cooling ◗ Lifetime of minimum 2,000,000 shocks ◗ Maintenance only necessary when performance drops, not obligatory at a certain amount of shocks. ◗ Applicator heads Diameters of 6 / 15 / 25 mm Power Consumption 250 VAC, 50-60 Hz. Contact details AVI Healthcare 25, Nanddeep Industrial Estate, Kondivita Lane, Andheri East, Mumbai – 59 Mobile: +91 9322294345 Tel: +91 22 28320452 Email: sales@avihealthcare.com
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TRADE AND TRENDS
Medisystems launches bed-head panels Wide range of bed-head panels for any application within hospitals MEDISYSTEMS BED-head panels are specially fabricated units for hospital use, designed to converge all the essential utilities around the patient's bed. These bed-head panels are configured to carry user terminals for electrical power, illumination, communications, biosignals, data, medical gas and carry a medical rail with a range of mountable accessories like examination lamps, BP instrument holder, case sheet holders, IV and infusion pump stands, bowl holders and the like. Medisystems circuit protected bed-head panels have now become part of ICU and patient room infrastructure in every hospital. Standard configuration panels are available for ICU, wards, private rooms / suites. Custom configurations to closely meet user requirements are also available. Medisystems bed-head panels are constructed from light weight extruded aluminium sheets and sections and from
stainless steel. The aluminium is surface treated with epoxypolyester powder coats in a seven stage process which ensures life time protection to the metal surface with ease of cleaning and ability to withstand damage from common hospital fluids like saline, drugs, blood etc. These light weight panels can also be mounted on non-brick walls made of siporex or gypsum board. All panels have safety metal partitions between high voltage, low voltage and medical gas outlets. Medisystems manufactures a very wide range of such panels to meet practically every kind of need. Such panels are available in standardised as well as custom configurations which include horizontal, vertical, running length or wall angular orientation, in colours and finish of choice.
Medisystems patient bed lamps Patient-bed lamps are designed
to accompany Medisystems bed-head panels or can be purchased individually. Medisystems patient-bed lamps have carefully profiled mirror optic reflectors, to throw uniform light towards the bed areas for examination or reading purposes. They are available in two feet and three feet lengths and mounted at a height of 1.85 m on the wall behind the patient’s bed. Patient bed lamps are made in light weight powder coated aluminium with glass diffusers and mirror optic reflectors. They come pre-fitted with uplighter, downlighter and LED night lamps. All lamps can operate independently. Made with energy efficient T5 FTL’s or LED tubes and electronic ballasts, they have long lamp life, low electricity consumption and are quick and easy to replace by hospital staff. Each lamp has a colour temperature of 6500 K cool daylight and is designed to give over 1150 lumens of uniform lighting ade-
quate for bedside areas.
Medisystems medical rail and accessories Medisystems also offers a range of medical rail mountable accessories. Each of these accessories is fixed on one or more sliders which can be smoothly moved on the rail and fixed at any desired location along the length of the rail. Medical rail accessories include case sheet holders, SS bowl for medicines , utility baskets, blood pressure instruments, IV poles, infusion pump stands, suction bottles, examination lamps and rail slider clamps for just about any mountable item. With more than 75 installations in hospitals and nursing homes all over the India and overseas, Medisystems undertakes the design, assembly, factory test, supply, delivery, field testing and commissioning of bed-head panels in standardised as well as almost any type of custom configuration or fin-
Horizontal room panel in wood finish
3elementPatient-bedLamp
ICU panel in horizontal orientation
Vertical panel for a private room in wood finish
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Customised panel in wood finish
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Horizontal panel for a private room
ish to meet the requirement of every type of hospital. Contact details medisystems@gmail.com
Vertical corner panel for ICU in wood finish
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Priceless purity
to guarantee your reputation Pharmalab, a name synonymous with quality and technology in the areas of sterilisation, washing, process equipment, sterility and water purification, now introduces total solutions for hospitals. Manufactured indigenously and in collaboration with world leaders.
Ultrasonic Washer
Steam Sterilizer
Washer Disinfector
Arcania Bedpan Washer
Vertical Chamber Autoclave
Pharmalab India Private Ltd. Kasturi, 3rd Floor, Sanghvi Estate, Govandi Station Road, Govandi, (East), Mumbai - 400 088. Tel no: 91-22-66 22 9900 Fax: 91-22-66 22 9800 E-mail: pharmalab@pharmalab.com www.pharmalab.com CIN No. U29297MH2006PTC163141
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Sterilizer Test Kit
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Cloud-based RIS PACS Tele Radiology solution by Healthfore with • • • • •
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Advance Streaming Tech Smart Hanging Protocols Advance Post Processing Digital & Voice Dictation Structured Template-Based Reporting & many more
Contact us for a free demonstration enquiry@healthfore.com / +91-97393 22622
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OXYGEN CONCENTRATOR OXYGEN THERAPY ..... REVITALIZE YOUR HEALTH
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Oxygen improves physical performance by up to 25%
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AIR MATRESS
ANTI-DECUBITUS MATTRESS
• Bubble mattress • 2 to 1 alternating therapy • Adjustable hangers for most bed types • Durable medical grade PVC • Extension flags for stabilization • High quality pump • Weight indicator pressure adjustment setting • 6 minutes cycling time • Near silent low noise • For prevention and treatment of patients at low risk of pressure ulcers
Medical grade PVC
2 to 1 alternating therapy
Ext
for stabilization
Easy to use adjustment
SKIN STAPLER
Benefits:
• The characteristics of the stapler's handle design for good texture and is suitable for various surgeon's hand. • Angled head provides clear view to ensure precise staple placement and the staple could enter the tissue easily. • The elaborate design of the staple release mechanism actuate the stapler with easy for using. • Easy to use, reduce learning curve. • Two model skin stapler, three staple sizes (wide, regular and high) and nine staple counts in stapler are true of all surgical field. SPECIFICATIONS : 7 mm 35 W
4 mm
Fine 316L Stainless Steel
Suggest Applications: Operation Room Outpatient Surgery
Labor & Delivery
Emergency Dept.
Clinics and Physician's Office
Hemant Surgical Industries Ltd. +91 - 96194 84952 +91 - 96194 84153 EXPRESS HEALTHCARE
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EXPRESS HEALTHCARE Advertise in
Business Avenues Please Contact: ■ Mumbai: Douglas Menezes 91-9821580403 ■ Ahmedabad: Nirav Mistry 91-9586424033 ■ Delhi: Ambuj Kumar / Gaurav Sobti 91-9999070900 / 91-9810843239 ■ Chennai/Bangalore: Mathen Mathew 91-9840826366 ■ Hyderabad: E.Mujahid 91-9849039936 ■ Kolkata: Ajanta 91-9831182580
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QDx Urine Analyzer
High on performance Testing speed of 522 tests/hour Data Memory 1000 test results "High luminosity cold light source re ection determination" technology.
"High Luminosity cold source re ection determination" technology Intrinsic "compensation pad" for abnormal samples. Specially designed strips with unique sequence. DiaSys QDx Urilyzer DS100 uses "Special Recognition Pad" on each strip making it a 100% Closed system.
QDx Urine Test Strips
INTRODUCING
ACR
DiaSys Diagnostics India Pvt. Ltd. Plot No. A -821, TTC, MIDC, Mahape, Navi-Mumbai - 400 710. Maharashtra, INDIA. Toll Free number : 1800 120 1447 | Email ID : info@diasys.in | www.diasys.in
EXPRESS HEALTHCARE
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Blood Bank Equipments
Blood / IV Fluid Warmer
Plasmatherm Blood Donor Chair
Blood Collection Monitor
Blood Bank Centrifuge
Biological Refrigerator
Platelet Incubator with Agitator
Benchtop Sealer
Centrifuge Bucket Equalizer
Blood Bank Refrigerator
Biological Deep Freezer
REMI SALES & ENGINEERING LTD.
Remi House, 3rd Floor, 11, Cama Industrial Estate, Walbhat Road, Goregaon (East), Mumbai-400 063. India Tel: +91 22 4058 9888 / 2685 1998 Fax: +91 22 4058 9890 E-mail: sales@remilabworld.com l Website: www.remilabworld.com
Advertise in
Business Avenues Please Contact:
■ Mumbai: Douglas Menezes 91-9821580403 ■ Ahmedabad: Nirav Mistry 91-9586424033 ■ Delhi: Ambuj Kumar / Gaurav Sobti 91-9999070900 / 91-9810843239 ■ Chennai/Bangalore: Mathen Mathew 91-9840826366 ■ Hyderabad: E.Mujahid 91-9849039936 ■ Kolkata: Ajanta 91-9831182580
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Advanced Syringe pump with drug library - stackable
Front loading Syringe pump - Stackable
YEARS OF AKAS
TRUSTED SINCE 1996
Thank You Customers MAX
A 12.1� PATIENT MONITOR
ECG + SPO2 + NIBP Monitor
NELLCOR
Original Module Option Available
DUO II
QVS-100
NIBP + SPO2 Monitor
Karnataka Kerala Madhya Pradesh Maharashtra Mumbai Odisha Punjab
Rajasthan Tamil Nadu Telangana Uttarakhand Uttar Pradesh
Infusion, Syringe Pumps Patient Monitors, Oxygen Concentrator, 1/2/3 Para Monitors
Ophthalmology Division LCD Vision Chart, A-Scan, B-Scan
Clinical Division Patient Spot Test, Infusion Controller
MP / AI / 02 / 2017/XPH
Andhra Pradesh Bihar Chhattisgarh Delhi Gujarat Haryana Jharkhand
QUICK VITAL SIGN
Mob: +91 98403 79116 240/1, Periya Colony, Athipet, Ambattur, Chennai 600 058. Tamilnadu, India. Ph:+91 44 3253 3333
EXPRESS HEALTHCARE
Fax:+91 44 2635 0030
Email: sales@akasmedical.com
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Manufacturing Neonatal Equipments “Glocally”
AVI Healthcare Pvt Ltd
ISO 13485:2003 CERTIFIED COMPANY
www.avihealthcare.com
Innovation for Newborn Bilipod LED Phototherapy Sleek, light weight, portable
NeoSmart Patient Monitor Nine Parameters SpO2 - Masimo NiBp - Suntech ECG Respiration Temperature Oxygen - FiO2 Apnea Detection CPAP Pressure Irradiance - Phototherapy
AVINA Bubble CPAP Bubble CPAP with inbuilt compressor and FiO2 Blender
ADDRESS: 25, Nanddeep Industrial Estate, Kondivita Lane, Andheri East, Mumbai - 400059, INDIA Telephone: +91 22 28320452/ +91 22 28326240 Email : sales@avihealthcare.com Mobile : +91 9322294345 (Chirag Gala) EXPRESS HEALTHCARE
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LIFE
Happy doctor’s day In nothing do men more nearly approach the gods than in giving health to men Roman philosopher, Marcus Tullius Cicero he nature of relationship between doctors and their patients underpins everything healthcare providers do, whether in general medicine, psychiatry or surgery. This relationship reflects the trust factor between healthcare providers and patients and therefore, it becomes an important element of medical practice.
T
In times, when the trust factor between doctors and patients is being questioned, Express Healthcare attempted to find that this trust still exists and to our amazement, several patients sent us good wishes for their doctors. Here is a glimpse of some special messages ...
KEDAR NATH ROY
DR AMARNATH SHAW Consultant Cardiac Surgery, Paras Global Hospital, Darbhanga
I am thankful to my doctor as he not only performed Mitral Valve Replacement (MVR) procedure successfully, but also ensured that I receive the best comfort and overcome the traumatic surgical experience. Instead of a long cut on my chest, today I have tiny nicks on the right hand side of my chest, highlighting that even today there are doctors who understand and empathise with the pain of their patients
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HEMANT PRATAP SINGH (PATIENT’S FATHER)
DR KANAV ANAND Consultant Paediatric Nephrologist, Sir Ganga Ram Hospital, New Delhi
W
e feel very lucky to find Dr Kanav Anand in our tough span of life. We will never forget his contribution in our daughter's life. We are very thankful to him for successfully treating our daughter, who was suffering from HSP Nephritis. He is a great doctor and in my opinion. Doctors like him are real gifts for our nation
RAJINDER PRASAD VERMA
DR NRIPEN SAIKIA Senior Consultant Gastroenterology & Hepatology, PSRI Multi-specialty Hospital
D
r Nripen is really a caring doctor, spends enough time with patients explaining all the doubts as well as about the diseases. He has a positive attitude and we are very glad and satisfied with the treatment. I highly recommend the doctors and this hospital
SUBRAMANIAM
DR SURESH RAO, HOD Critical Care & Cardiac Anesthesia, Fortis Malar Hospital Chennai
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I
t has been a year now since my successful heart transplant surgery was conducted. At the age of 79, it was challenging for me to undergo a heart transplant. But I was fortunate to have had my family and doctors who were specialists in transplant surgery. My doctor is soft spoken and a caring person. He was always been positive and helped me both physically and mentally and took personal care of me. We became friends and we still are
SAMEER MALHOTRA
DR DEEP GOEL Director, Surgical Gastroenterology, Bariatric & Minimal Access Surgery, BLK Super Speciality Hospital
H
e was always there to answer my queries that I had. He explained to me every pros and cons of the surgery and never kept me in the dark about anything. Post operation, during my still in the hospital, Dr Goel came to see me everyday – sometimes two to three times in a day. I really appreciate this. Thank you, Dr Goel, for changing my life not only for me, but for my family as well
AVANI
DR BINA VASAN Director & Head Reproductive Medicine, Manipal Fertility
M
y doctor helped me convert my distant dream to a reality. Dr. Bina Vasan has given me my bundle of joy and helped me in enjoying motherhood bliss. I was advised Preimplantation Genetic Screening (PGS), a procedure used to examine embryos for genetic/chromosomal defects, before implantation was possible.She gave me the courage and strength to opt for this technology and the result was marvelous
KALPANA
DR JAYANTHI S THUMSI In Charge, Dept. of Breast Oncology at BGS Gleneagles Global Hospitals, Bengaluru
W
hen I underwent mastectomy, she gave me lot of courage saying that you are young and can overcome this. It was third stage and I followed what she guided me to do including precautionary measures. I have developed confidence in her. She is an excellent doctor who builds an amazing relation with her patients. She will call you to know how you are coping. She will attend calls and spare the time to clear all your doubts.
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MANU
DR SUBRAMANIA IYER Head (plastic surgery), Amrita Institute of Medical Sciences, Kochi
M
y doctor is special because his place is in the shrine of my heart. I had to undergo double hand transplant, as I lost both my hands in 2013 when I was thrown off a train while trying to save a couple from harassment
VIJAY DARKONDE
DR PRADEEP V MAHAJAN Regenerative Medicine Researcher, StemRx Bioscience Solutions
I
was diagnosedwith Avascular necrosis 12 years back. It was Dr Pradeep Mahajan, who gave me a ray of hope towards better living. A doctor-patient relationship is based on trust and faith which works both ways. Dr Mahajan has faith in his novel therapeutic approach for various health conditions and I trusted his expertise in the matter. He holds a special place in my life
SALVI PATEL
DR KM CHERIAN Chairman and CEO of Frontier Lifeline Hospital
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D
r Cherian is kind, humble and friendly in nature. He treats his patients very well. I am so lucky to have received treatment under him. He helped in many ways. He supported me in way of mentally and financially. He motivated and encouraged me and I was ready to go for transplant. Whatever I will say about him is less because he deserves a lot. I cannot describe him in mere words‌..
DR TUSHAR PAL CHOUDHURY
DR AASHISH CHAUDHRY,
H
he is an excellent human being who could feel my pain and distress and helped me to overcome the fear of surgery. He not only performed a highly successful knee replacement surgery but also guided his entire care team for my speedy recovery. It was a great experience as he treats his patient like one of his family members
Managing Director and Orthopaedic Surgeon, Aakash Healthcare
KIARA (PATIENT’S FATHER)
M
y daughter was suffering from Type I Juvenile Diabetic and she was referred to Dr Atish Laddad by my family members. He has been our guide throughout. Be it day or midnight, he answered all our queries patiently and guided us throughout our fight against the complication and successfully treated our child.I feel he has not only saved one life but my complete family
DR ATISH LADDAD Pediatrician and Founder Member, The Pediatric Network
RAVINA BELANI
DR PRATHIMA REDDY Director & Senior Consultant, Obstetrics & Gynaecology, Fortis La Femme
I
had to undergo a complicated hysterectomy. Dr Reddy took charge and all my procedures were done in perfection. My aftercare was looked into by her too and every minute details were monitored by her. Till today, I am under her care. I am thankful to Dr Reddy for her precise and timely diagnoses and perfect surgery. Her human and healing touch gave me a second life. Her confidence gave me confidence
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PARICHER AFLATOON KHAIRABADI
DR PRAVEEN KULKARNI DM – Cardiology Consultant – Cardiology (Invasive & Non-Invasive), Global Hospitals, Mumbai
H
he’s the one who perfectly understands the key part of getting the care which is best for me. With him, it feels at ease to discuss about my health concerns affecting my life and the things to do in order to improve it. The moment I feel that things aren’t getting better, I get in touch with the doctor because more than facing the doctor directly, improving the situation is more important. It’s your health and you solely have the right to find the best doctor for you. Sometimes, it’s very easy to forget how valuable good doctors are, until you go through an injury or illness
YOGITA S MORE
DR ANITA SONI Gynaecologist, Dr LH Hiranandani Hospital
S
she is empathetic and compassionate towards her patients. Her confidence motivates me to overcome any fear I have regarding my health.Her believe in me and my suffering, be it physically or emotionally reassures me and makes me feel safe. Kindness is one of the best attribute she possesses. She treats any form of query/doubt from my side with undivided attention
AMREEK SINGH
DR TS KLER Executive Director, Cardiac Sciences, Fortis Escorts Heart Institute, New Delhi
M
y doctor is special because.. of his sincerity and honesty towards his work... Personally I believe I've seen god on earth
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