Express Healthcare (Vol.12, No.4) April, 2018 by Indian Express

VOL.12 NO 4 PAGES 68

Market Healthcare Senate, Coming Soon Policy Arun Singhal, Joint Secretary, MoH&FW www.expresshealthcare.in APRIL 2018, `50

ANSELL, A GLOBAL LEADER IN PROTECTION SOLUTIONS, OFFERS A COMPREHENSIVE LINE OF HEALTHCARE SAFETY SOLUTIONS DESIGNED TO ADDRESS INJURY PREVENTION AND INFECTION CONTROL IN HIGH-RISK HEALTHCARE ENVIRONMENTS. Through collaboration with nurses, surgical teams and healthcare experts, Ansell continues to offer the most innovative solutions for improving outcomes for both patients and healthcare workers. On top of sharps safety, staff & patient ergonomics, ﬂuid & trip management, never event protection, SANDEL Healthcare Safety Solutions now address facial protection. SANDEL® Facial Protection solutions are designed to reduce the risk of cross-contamination in protecting healthcare staff and patients from airborne diseases. Facial Protection also help reducing the exposure of healthcare workers to blood and bodily ﬂuids splashes.

THE COMPREHENSIVE SANDEL FACE MASKS RANGE OFFERS THE COMFORT YOU HAVE ALWAYS WANTED, WITHOUT SACRIFICING PROTECTION: SCAN THIS QR CODE TO LEARN MORE ABOUT ANSELL SANDEL FACE MASK RANGE J. K. Ansell Private Limited Raymond Complex, Pokhran Road No.1, Jekegram, Thane (West) 400 606 II Tel: (022) 6152 7000 • Fax: (022) 6152 7752 medical@jkansell.in • www.ansell.com Ansell, ® and ™ are trademarks owned by Ansell Limited or one of its affiliates. © 2017 All Rights Reserved.

Redefining a cost-of-ownership CT solution

CONTENTS Vol 12. No 4, April 2018

Chairman of the Board Viveck Goenka Sr Vice President-BPD Neil Viegas Editor Viveka Roychowdhury* Chief of Product Harit Mohanty BUREAUS Mumbai Usha Sharma, Raelene Kambli, Lakshmipriya Nair, Sanjiv Das, Mansha Gagneja Swati Rana

A NEW PARADIGM IN INDIA’S PUBLIC HEALTH

Delhi Prathiba Raju Design National Design Editor Bivash Barua Asst. Art Director Pravin Temble Chief Designer Prasad Tate Senior Designer Rekha Bisht Graphics Designer Gauri Deorukhkar Artists Rakesh Sharma

The two-day conference saw public health experts deliberate on strategies to eliminate barriers to increase efficiencies in delivering quality,reliable and equitable health services in India.Moreover,public health torchbearers from various states were also honoured at the Express Public Health Awards held concurrently | P-22

MARKET

STRATEGY

Digital Team Viraj Mehta (Head of Internet) Dhaval Das (Web Developer)

HEALTHCARE SENATE, COMING SOON

Photo Editor Sandeep Patil

11 12

SYMHEALTH 2018 TO BE HELD IN PUNE

MARKETING Regional Heads Prabhas Jha - North Harit Mohanty - West Kailash Purohit – South Debnarayan Dutta - East

TRADE AND TRENDS

SKIN DONATION: NEED OF THE HOUR

‘A NEW COMPETENCYBASED CURRICULUM FOR MBBS WILL BE INTRODUCED FROM 2019-20’

Marketing Team Ajanta Sengupta, Ambuj Kumar, Douglas Menezes, E.Mujahid, Nirav Mistry, Rajesh Bhatkal, Sunil Kumar

INTRODUCING GEN-NEXT ANALYSERS BY DIASYS

PRODUCTION General Manager BR Tipnis

CARESTREAM USES WIRELESS DIGITAL X-RAY TECHNOLOGY AT NFL COMBINE

Manager Bhadresh Valia Scheduling & Coordination Santosh Lokare CIRCULATION Circulation Team Mohan Varadkar

WOMEN ARE POSSIBLY ACCESSING KIDNEY HEALTH LESSER AND LATER, MISSING AN OPPORTUNITY TO DETECT KIDNEY DISEASE IN AN EARLY PHASE

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 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.

EXPRESS HEALTHCARE

April 2018

EDITOR’S NOTE

Ayushman Bharat: The countdown begins

he Cabinet’s approval of Ayushman Bharat – National Health Protection Mission (AB-NHPM) on March 21 officially sets the ball rolling on the implementation of this flagship programme of the Narendra Modi government. nd August 15, India's 72 independence day is rumoured to be the targeted launch date, as the PM had first spoken about a healthcare scheme for families Below the Poverty Line from the ramparts of Red Fort in his 2016 I-Day address. However, Union minister for Health and Family Welfare JP Nadda has said Modicare would be fully functional by October, possibly on the 2nd, which is the birthday of Mahatma Gandhi. As this will be Prime Minister Modi's last I-day address in this term, the success or failure of AB-NHPM will significantly impact 2019 general elections. There is no doubt that there is a sense of urgency. Consultations with the directors and key staff of the National Health Missions of the states were held in March itself, both in Delhi as well as in various state capitals. These consultations will continue through April, as Naddaji is set to hold zonal meetings with the states along with his two Ministers of State, Ashwini Kumar Choubey and Anupriya Singh Patel, to fine-tune the system. The success of the scheme rests on at least four crucial factors. First, a rigorous vetting of the Socio Economic and Caste Census (SECC) data. This needs to be done at the gram panchayat level of every state as the approximately 10 crore beneficiary families will be identified on the decided deprivation categories based on this data. Reports indicate that April 14 has been set as the date for the Health Ministry and the Gram Swaraj Abhiyan of the Rural Development Ministry to carry out this exercise. The scheme is very well intentioned, intending to cover almost all secondary care and most of tertiary care procedures. Moreover, there will be no cap on family size and age and also include pre and post-hospitalisation expenses, as well as all pre-existing conditions. A release also states that a defined transport allowance per hospitalisation will also be paid to the beneficiary. Adjusting these claims against a defined benefit cover of `5 lakh per family per year, looks like a tall task but at least a start has been made. According to a timeline shared by Naddaji, April will also see seven working groups sharing operational guidelines, model of the tender and

EXPRESS HEALTHCARE

April 2018

The success of the scheme rests on at least four crucial factors: vetting the SECC data, structuring of disease packages,a robust IT infrastructure and deciding criteria to empanel and monitor private hospitals

contract, drafted by them with the states. A CEO for the national health agency will be appointed. This is a key post as this agency will anchor the registration and operationalisation of the 1,347 packages, listing diseases and related procedures covered by the scheme. The second crucial task, therefore is structuring of these packages and deciding costs associated with the treatment. Each state/UT will be given the flexibility to modify these rates within a limited bandwidth, subsume existing schemes into AB-NHPM as well as choose the mode for implementation, that is through an insurance company, directly through a trust/society or a mix of both models. Approving packages tweaked by states will be a tricky balancing act as all parties have used health schemes to appease votes banks. Thus, AB-NHPM officials will have to tread very carefully if they want their cooperation. The third crucial aspect is the functioning and monitoring of insurance-based reimbursements, once the scheme is operational. This needs IT infrastructure geared to detect frauds/misuse even as it aims to be paperless, cashless and portable. Recognising this, the ministry will make pre-authorisation mandatory for certain treatments deemed to have a high potential of misuse, as well as have a grievance redressal mechanism . Thus, the IT system will be the backbone of AB-NHPM, and one hopes that all safeguards will be put into place. May 30 has been set as the deadline for its design in consultation with NITI Aayog while June will be devoted to test and finalise it. State and district officials are to complete their training in June while states complete awarding of tenders and empanelment of hospitals in the same month. The fourth crucial aspect is deciding criteria to empanel and monitor private hospitals. All public hospitals in the states implementing AB-NHPM will be deemed empanelled for AB-NHPM while hospitals belonging to Employee State Insurance Corporation (ESIC) may also be empanelled based on bed-occupancy ratio. The criteria for private hospitals will be crucial to ensure there is no misuse of the system. Implementing AB-NHPM seems like a tall task but nothing ventured, nothing gained seems to be the motto of this government. Let’s hope implementation lives up to intent. VIVEKA ROYCHOWDHURY Editor viveka.r@expressindia.com

MARKET PRE EVENTS

Healthcare Senate,coming soon The event will focus on 'Strengthening Values for Sustainable Growth'

xpress Healthcare invites CXOs of hospital chains, medical directors, owners/ promoters of hospitals and diagnostic centres, consultants, thought leaders, industry stalwarts and domain experts to congregate at India's largest private sector business summit to prepare a blueprint based on values that will make healthcare organisations successful both in terms of profitability and goodwill. The first two editions of Healthcare Senate held in Hyderabad served an excellent platform for thought leaders, key decision makers, investors and budget holders to share and exchange strategies that are relevant to the fast changing healthcare environment as well as helpful in running sustainable, responsible and profitable businesses in India. All stakeholders therefore, came together to share their insights on business models that will work for India. The first edition focussed on ‘Value-based healthcare delivery’, while the second edition was ‘Building a future ready healthcare sector for India’. Taking these discussions

further and in keeping with the rapidly changing healthcare business environment, Healthcare Senate's 3rd edition, scheduled in July 2018, will focus on 'Strengthening Values for Sustainable Growth'. The summit and its discussion will emphasise on inculcating the below mentioned core values that will lead healthcare business to create value for all.

Ingredients for a successful organisations: ◗ Integrity: There are no moral shortcuts in the game of business or life. It is the true mark of leadership and so healthcare organisations who wish for sustainable growth will have to instill this principle in all their business dealings; be it patients, employees or partners. Healthcare organisations which operate with integrity and honesty earn immense brand value. At Healthcare Senate 2018 industry stalwarts will share their stories of success which speak of goodwill and profitability earned through integrity and honesty in business.

◗ Accountability: This is a virtue that healthcare organisations cannot overlook. Accountability entails the procedures and processes by which healthcare providers justify and take responsibility for their activities. Lack of accountability in healthcare therefore, can cause significant damage to organisations. It can erode quality of care, ruin an organisation’s reputation, and increase the risk of lawsuits. Experts, in their discussion, will deliberate on ways and means to improve accountability of care. ◗ Quality: Quality in healthcare should be more than making the best product or providing the best service. It should extend to every aspect of the business function. A company that recognises quality and strives for it daily has a profound sense of self-respect, pride in accomplishment, and attentiveness that positively affects every aspect of its business. At the conference, healthcare quality experts will share insights on how striving for quality facilitates organisations to improve efficiency and achieve profitable in the long run.

◗ Innovation driven: Industry leaders will explain how innovative companies deliver a consistent stream of market successes via successful businesses and products/services or improved processes that continuously translate market success into economic value. These companies enjoy a competitive advantage and achieve sustained growth. ◗ Adaptability: With changing business dynamics the challenge that healthcare organisations face is keeping pace with these changes. Organisations which can roll with change and still perform well are prime time players and will enjoy sustainable growth. The event will bring forth case studies of such companies which have gracefully accepted change and gained better outcomes. ◗ Strategic Partner Relationships: No business is successful if it is not built on values forged and strengthened by strategic partnerships. Here, experts will highlight the essentiality of striking sustainable partnerships which can help companies gain competitive advantage and credibility.

Topics to be covered during the event are: ◗ Healthcare 2.0: Creating value for all ◗ Creating an inclusive healthcare ecosystem for India ◗ NHPS: Building the right synergies ◗ Growth Agenda: The battle for sustained innovation leadership in healthcare ◗ Access strategies in a era of price control ◗ CEO Round table: Business culture: Why core values matter? ◗ Healthcare's unique treasury management challenge ◗ Regulating trade margins the do's and dont's On the side lines of Healthcare Senate 2018, Express Healthcare will also be hosting Radiology and Imaging conclave and the the Healthcare IT Senate. Both these knowledge platforms will gathers experts from the field of radiology and It to share in depth knowledge on the Future of radiology and the healthcare IT. Contact: Vinita Hassija Email id: vinitahassija@gmail.com Phone no: 98205990053

SYMHEALTH 2018 to be held in Pune The national conference on interdisciplinary approach to healthcare will be held from May 3, 4 and 5 IN CONTINUUM of its annual initiatives, the Faculty of Health and Biological Sciences (FoHBS), Symbiosis International (Deemed University) will organise SYMHEALTH 2018 at SIU Lavale, Pune. The event will be held on May 3, 4 and 5, 2018.

EXPRESS HEALTHCARE

April 2018

SYMHEALTH, an annual mega event with a legacy of 19 years, has been attracting around 1200 professionals from all verticals of the healthcare such as hospitals, insurance, IT, Medical equipment and devices companies, medico legal firms, NGOs,

clinical research organizations, from all over India and abroad. It is an event that marks the significance of integrating ideas and information from across many disciplines. The conference will have sessions chaired by a cohort of stalwart

speakers, contemporary topics and will provide opportunities for stakeholders beyond academia and industry, to exchange insights, present emerging opportunities, make networking connections and to share resources. The theme this year is ‘In-

terdisciplinary Approach to Healthcare' which underscores the importance of applying integrative strategies to the theory and practice of health sciences. The conference will highlight some such contemporary issues in healthcare that cannot be dis-

The theme this year is ‘Interdisciplinary Approach to Healthcare' which underscores the importance of applying integrative strategies to the theory and practice of health sciences. The conference will highlight some contemporary issues in healthcare cussed insularly and beg the context of a wider discourse. A day prior to the conference a unique event ‘Connexions’ is organised. ‘Connexions’ presents an opportunity for delegates to learn about various skill sets and competencies which need to be acquired by healthcare professionals. A placement assistance drive will be conducted which will facilitate interested enrolled candidates to interact and get interviewed with prospective recruiters. Several eminent national speakers including Air Marshal Pawan Kapoor, AVSM, VSM Director General Medical Services (Air), Retd, Dr Rajendra Patankar COO, Nanavati Hospital, Mumbai; Dr HP Singh, Chief of Medical Administration, Indian Spinal Injuries Centre, Delhi; Arnab Chaudhury, MD Life Sciences & Healthcare, Deloitte Consulting; Shishir Gupta, National Manager- Strategy & Innovation, Roche Diagnostics; Dr Sanjay Dalsania, GM Quality, Apollo Hospitals, Navi Mumbai; Dilip Jose, MD and CEO Manipal Health; Dr Geeta Bharadwaj, GM-Operations, MD India Healthcare Services; Dr Naveen Tirkey, Trial Lead, Global Business Services, Novartis; Dr Rohini Kelkar, Head Microbiology Dept, Tata Memorial Hospital, Mumbai; Tirupathi Karthik, CEO, Napier Healthcare Solutions; Dr Gaurav Thukral, Executive VP, Health Care at Home India; Dr Shyam Vasudevrao, Founder & Chairman, Renalyx Health Systems; Anurav Rane- Founder & CEO- Planmymedtrip; Raj Gore, Vice President – Operations, Fortis Healthcare; Dr Gopinath Shenoy, Medico Legal Expert. The valedictory ceremony will be held on May 5, 2018 in

EXPRESS HEALTHCARE

April 2018

the august presence of Dr Poonam Khetrapal, WHO Regional Director for SouthEast Asia and Dr Dileep Mhaisekar, Vice-Chancellor, Maharshtra University of Health Sciences (MUHS). Adv. Ram Jethmalani, MP Rajya Sabha will also grace the occasion as Guest of Honour.

DEFIBRILLATORS Treatment for Life-Threatening Cardiac Dysrhythmias

DEFIGARD 400

CARDIOPLUS

FRED easy®

FRED easyport®

FRED PA-1

POLICY I N T E R V I E W

â&#x20AC;&#x2DC;A new competency-based curriculum for MBBS will be introduced from 2019-20â&#x20AC;&#x2122; A new competency-based curriculum for MBBS will be introduced from 2019-20, informs Arun Singhal, Joint Secretary, MoHFW, in an interaction with Prathiba Raju. He further highlights about the advantages of NEXT, NEET and NMC

Many state government and student authorities of the Medical Council of India (MCI) are not convinced by NEXT (National Exit Test). What are your views on this issue? The concern of students over a licentiate exam at the end of five and half years of study is understandable. However, the need for a licentiate exam was felt to ensure quality of medical doctors graduating from medical colleges and to move to outcome-based monitoring of medical colleges rather than processoriented monitoring. This licentiate exam will also be taken by foreign medical graduates. Thus, the licentiate exam will become a single window examination for medical graduates with degrees from foreign universities to study and practice further in India. Many medical students and parents complain that graduating as a doctor is probably one of the most time-consuming courses. As already five and a half years goes in completing a degree. Two years in MD or MS and another couple of years on DM/MCh. Medicine is a vast field of study and the profession of medical doctors is one of great responsibility. The curricula of medical courses, both undergraduate and postgraduate, have been designed by experts under the aegis of Medical Council of India (MCI) and the duration of courses has been set to comprehensively educate and

EXPRESS HEALTHCARE

April 2018

train individuals aspiring to practice medicine. The Government of India is going to introduce a new curriculum for MBBS this year with a much higher focus on skills and competencies. The intention is to produce MBBS doctors who can provide primary treatment for all major ailments as far as possible, so that there is space for MBBS doctors to contribute effectively towards healthcare in the country. This curriculum is of crucial importance in the context of timing of the licentiate exam. There is a school of thought that the licentiate exam, which would have theory and skills components, can now be held after four and a half years of the MBBS programme, so that students can focus on acquiring practical knowledge during their internship rather than spending time on coaching for NEET-PG or licentiate exam. The final view in this regard would of course be taken by National Medical Commission after its formation. Can you elaborate on the benefits of the NEET exam and why certain states like Tamil Nadu is opposing it? It is the first time that a uniform entrance examination has been implemented over the entire country including private colleges and deemed universities in any sphere of higher education. Medical aspirants now do not need to take multiple exams for admission to graduate

Regulation of fees of 40 per cent seats is definitely a step in the right direction. The proportion of regulated seats has a direct impact on the fees of remaining seats and a reasonable balance has to be struck

medical courses. NEET has also led to curbing of corruption surrounding admission to undergraduate level courses by putting in place a transparent examination and counselling process. All states, including Tamil Nadu, have now successfully introduced NEET.

in the IMC Act. Regulation of fees of 40 per cent seats is definitely a step in the right direction. The proportion of regulated seats has a direct impact on the fees of remaining seats and a reasonable balance has to be struck so that the fees of unregulated seats do not become unviable.

How will National Medical Commission Transform medical education in India? How will the proposed National Medical Commission prove to be more effective than the existing Medical Council of India? How will it curb corruption in medical education? A rigorous and independent selection of members through a transparent process will ensure greater accountability. It is meant to put an end to the oppressive regime of inspections carried out by MCI and spur investment in the medical education sector by simplifying procedures and focusing on outcomes instead. It is not in any way meant to inconvenience students, but to facilitate provision of better quality of education to more and more students at reasonable fees.

Allowing traditional medicine practitioners into allopathy has triggered a major debate. Do you think it is a good move? Reasons. There is a shortage of allopathic doctors in the country. They are indispensable as far as tertiary and secondary level care is concerned. However, at the primary and preventive care level, routine ailments can be handled by individuals with shorter duration courses or courses with alternate specialisations, as they already possess basic knowledge of medicine and, in many cases, are already providing care at the primary level. The proposal is to allow limited powers of prescribing allopathic medicines after undergoing a scientificallydesigned bridge course.

Many public health workers inform that cost of medical education may increase if the government has limited control on the fees that colleges can charge medical students? There was absolutely no provision of regulation of fees

When we talk about higher education in pharmacy many students opt to go abroad like Ireland, China, Malaysia and the US. Is there not enough opportunity here in India? The dual control of pharmacy education by Pharmacy Council of India and All India Council for

Technical Education has been a issue for a long time and it is affecting quality and prospects of pharmacy professionals for some time now. Your comments. We have a reasonable numbers of pharmacists in the country. The demographic dividend available to us provide huge opportunities to fulfill demand of allied health professionals all over the world. Is there any specialised course in nursing, which is on anvil, many nurses urge that introduction of M.Sc in Critical Care Nursing and inform that it will help to upgrade the nursing practice and integrate nursing education with bedside practice. Do you think hospitals should also go in for Nursing Excellence Accreditation by NABH which will improve overall standards? Your comments. A two-year post graduate residency programme titled the Nurse Practitioner in Critical Care (NPCC) programme has been launched by the Ministry of Health & Family Welfare in 2017-18 with an aim to prepare registered B.Sc nurses for advanced practice with specialised competencies/skills to function as expert nurses. These specialised nurses will function in ICUs as trained and empowered human resources to provide safe, competent and cost effective critical care. Establishment of accreditation processes always result in improvement in quality. Any step that envisions improvement in quality of care would always be encouraged. Overall how do you see the medical education in India? Can we, as a nation, take lessons from other countries on a particular model for medical education? India is a unique democracy with its own advantages and challenges. The field of medical

EXPRESS HEALTHCARE

April 2018

education in India has seen revolutionary changes in recent times. From multiple, time consuming, entrance examinations for admission to undergraduate medical courses, we have now moved to one single entrance

examination, which is a first-ofits-kind step in the country. A new, competency-based curriculum for MBBS is being introduced from 2019-20 onwards. Medical education cannot be seen in isolation with factors like service delivery

conditions, infrastructural capabilities of the states and, to some extent, political will. Policy-making, therefore, has to be a dynamic process, especially in a country like India, where regional variations have to be accounted for while

setting standards and laying down guidelines at the Centre. As a nation, we need to utilise the most feasible and practical models based on learnings from different experiences around the world. prathiba.raju@expressindia.com

POLICY OPINION

Will NHPS work? The answer is in the details Dr Somen Saha,Faculty,Indian Institute of Public Health Gandhinagar and Dr Sudha Chandrashekar, Public Health Expert and Health Economist,give insights on NHPS and the strategies to optimise its potential THE UNION Budget 2018’s announcement on healthcare is being hailed as the ‘world’s largest healthcare programme’, also dubbed as ‘Modicare’. Under Ayushman Bharat initiative Government of India announced National Health Protection Scheme (NHPS) to provide financial protection for secondary and tertiary care illness that require hospitalisation. NHPS aims to provide a coverage of `5 lakhs per family to 100 million families. Critics immediately term the initial `2,000 crores allocation for the scheme as grossly inadequate. Some analyst suggested this allocation works out to only ` 40 for each person and questioned the logic behind the allocation. The more hawkish analyst, particularly from general insurance companies argued that such schemes will cost upward `50,000 crores with an annual average premium for per family in the range of ` 4,000 – 5,000. So, is the government ill-informed in its calculation? Our argument is No. Although the contours of NHPS is not out in public, it is very likely that it will subsume existing, centrally-

EXPRESS HEALTHCARE

April 2018

Dr Somen Saha, Faculty, Indian Institute of Public Health, Gandhinagar

funded Rashtriya Swasthya Bima Yojana (targeted mostly at secondary care hospitalisation) and parallel schemes funded by state governments (mostly for catastrophic, tertiary care illness) into a ‘single payer’ mechanism. Such state funded schemes – Vajpayee Arogyashri in Karnataka, Mukhyamantri Amrutam Yojana in Gujarat, Aarograshri in Andhra Pradesh, Bhamashah Swasthya Bima Yojana in Rajasthan, Mahatma Jyotiba Phule Jan Arogya Yojana in Maharashtra, among others – already offers health cover to the extent of ` 1 – 3 lakhs. An analysis of existing state sponsored

schemes in India shows the average annual premium size for covering catastrophic tertiary care hospitalisation expenses is about `1,000 per household and average claim payout is around Rs 60,000. This clearly shows increasing the coverage to `5 lakhs per family gives a huge political dividend without necessarily stressing the public exchequer. The government showed fiscal prudence by not front-loading the financial allocation in the first year thereby allowing to bootstrap the allocation over a period of time. The details of NHPS needs to be carefully worked out. It should not turn out to be a windfall gain for private hospitals. Instead, it should strengthen public hospitals and involve private hospitals for specific procedures. This will be possible by involving a gatekeeping system that rationally direct beneficiaries to care providers. The government can clearly cut administration cost by following an assurance model that does not pass the premium amount to an insurance company. However, this will depend on the capacity of states to have structures and systems to manage

Dr Sudha Chandrashekar, Public Health Expert and Health Economist

such large-scale health protection programme. Existing best practices and challenges in programme implementation needs to be considered in planning for such a roll out. This will need consultation with states, implementation partners and other professional bodies for smooth roll out. In particular, it calls for improvement in scheme management capacity, faster decision making process, and capacity building of the states. An important challenge for NHPS might be bringing existing, state-funded health protection schemes under a single authority. While this will bring

efficiency in the system, an alternative arrangement could be co-branding NHPS with existing state schemes to enable better buy-in from states. Strategic purchasing of healthcare through NHPS demands increased capacity for defining the package of services, appropriate skills in costing of healthcare packages that are sensitive to variations in cost of care, setting standard management guidelines and monitoring quality. NHPS can play a major role in controlling cost of care. Under a single-payer model, NHPS can have the leverage to control cost of healthcare through strategic purchasing that no scheme has had so far. The other big challenge would be covering out-patient treatment and prescription medicine that is known to have the greatest impact on cost of care. NHPS needs involvement of civil societies to promote awareness about entitlement, develop a system to gather data and research to understand the scheme’s impact on out-ofpocket expenditure, hospital utilisation and explore the potential to expand the base through a contributory mechanism from the not so poor.

POLICY NEWS

NHPM to protect about 50 cr people from catastrophic healthcare spending According to the Union Health Minister, NHPM will serve the poor in the country as there is an increased benefit cover to nearly 40 per cent of the population, covering almost all secondary and many tertiary hospitalisations THE UNION Cabinet chaired by Prime Minister, Narendra Modi has approved the Centrally Sponsored National Health Protection Mission (NHPM) having central sector component under Ayushman Bharat, anchored in the Ministry of Health and Family Welfare. Thanking the Prime Minister for his visionary leadership and constant guidance, JP Nadda, Union Minister of Health and Family Welfare, said that NHPM is a major step towards Universal Health Coverage. It will protect around 50 crore people (from about ten crore families) from catastrophic healthcare spending. This shall boost our resolve to serve the poorest of the poor in the country as there is an increased benefit cover to nearly 40 per cent of the population, covering almost all secondary and many tertiary hospitalisations, he said. Nadda further stated that the coverage of ` 5 lakh for each family has no restriction of family size and age. “This will give underprivileged families the financial support required when faced with illnesses requiring hospitalisation,” Nadda added. Families belonging to poor and vulnerable population based on Socio Economic Caste Census database shall be benefitted through the Ayushman Bharat-NHPM. NHPM will subsume the on-going centrally sponsored scheme “Rashtriya Swasthya Bima Yojana” (RSBY) and Senior Citizen Health Insurance Scheme (SCHIS). Poised to be the largest public funded health insurance scheme in the world, the Union Health Minister further said that the beneficiaries can avail of the benefits in both public and empanelled private facilities. “All public hospitals in the states implementing Ayushman BharatNHPM, will be deemed empanelled for the scheme. As for private hospitals, they will be empanelled online based on defined criteria,” Nadda said.

EXPRESS HEALTHCARE

April 2018

KNOWLEDGE

Skin donation: Need of the hour Dr Suhas Abhyankar, Consultant Plastic and Reconstructive Surgeon, Eric Kharas Burns Research Centre, Masina Hospital, talks about the need to create more awareness on skin donation, which can be a boon for patients with critical skin issues

he human skin is the largest organ in the human body. It shields us from harmful effects and enables us to mend itself from wear and tear. Loss of skin removes protective barrier against bacterial invasions and make the patient vulnerable to infections. However, when the skin damage is critical, measures like skin transplant is undertaken. We are mostly aware of blood, organ, cadaver and eye donations but lack awareness of skin donation. By donating skin, it provides a better quality of life for people suffering from severe burns and injuries. The donated skin is processed and stored in a skin bank before transplantation. An awareness about skin donation is the need of the hour in order to resolve one of the most perilous issues in medical science. Generally, in the absence of a skin bank, doctors use the healthy skin of the patient by grafting it and reusing it in plastic surgery. However, this is a delayed recovery process. In today’s advanced infrastructure, skin banks is a boon in medical history, as patients do not require a match in blood group and the burn victims can be

HEAD OFFICE Express Healthcare® MUMBAI Douglas Menezes The Indian Express (P) Ltd. Business Publication Division 1st Floor, Express Tower, Nariman Point, Mumbai- 400 021 Board line: 022- 67440000 Ext. 502 Mobile: +91 9821580403 Email Id: douglas.menezes@ expressindia.com Branch Offices NEW DELHI Sunil Kumar The Indian Express (P) Ltd. Business Publication Division Express Building, B-1/B Sector 10 Noida 201 301 Dist.Gautam Budh nagar (U.P.) India. Board line: 0120-6651500. Mobile: 91-9810718050

EXPRESS HEALTHCARE

April 2018

saved if a barrier is created by grafting new skin donated as ‘allografts’. Any person devoid of HIV, Hepatitis B or C, STDs (sexually transmitted diseases), Septicemia, skin cancers or skin diseases can also donate skin. ‘Allografts’ acts as a biological dressing thus helps in preventing infections, reduces pain and also gives mechanical protection. Thereby, accelerates the

Fax: 0120-4367933 Email id: sunilkumar@expressindia.com CHENNAI Kailash Purohit 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 9552537922 Email id: kailash.purohit@expressindia.com BENGALURU Kailash Purohit The Indian Express (P) Ltd. Business Publication Division 502, 5th Floor, Devatha Plaza,

process of healing. This results in less scars, contractures and minimal permanent disfigurement. The concept of skin donation after death is not a new process and the first skin bank was established in the US around 1950. Burn prevention is one of the major public health programmes around the world. Various studies shows that most

Residency road, Bangalore- 560025 Board line: 080- 49681100 Fax: 080- 22231925 Mobile: +91 9552537922 Email id: kailash.purohit@expressindia.com HYDERABAD E Mujahid The Indian Express (P) Ltd. Business Publication Division 6-3-885/7/B, Ground Floor, VV Mansion, Somaji Guda, Hyderabad – 500 082 Board line- 040- 66631457/ 23418673 Mobile: +91 9849039936 Fax: 040 23418675 Email Id: e.mujahid@expressindia.com KOLKATA Ajanta Sengupta The Indian Express (P) Ltd.

people die due to burn injuries than other infectious diseases. Approximately, around 1, 20,000 to 1, 40,000 people die every year in India due to burns. Donation should be done within six to eight hours of donor’s death. This long intensive process of skin transplantation is carried out by a team of dedicated doctors who initiate the lengthy procedure starting with the pa-

Business Publication Division JL No. 29&30, NH-6,Mouza- Prasastha & Ankurhati,Vill & PO- Ankurhati, P.S.Domjur (Nr. Ankurhati Check Bus Stop) Dist. Howrah- 711 409 Mobile: +91 9831182580 Email id: ajanta.sengupta@expressindia.com

tient's consent and verified documents, the team proceeds for harvesting various parts of the body. Only 1/8th thickness part of the skin is taken using a special instrument called Dermatome and the processed skin is stored at minus 80 degrees in a special storage freezer. The donor skin and dermal grafts are used in several types of loss of substance for different

AHMEDABAD Nirav Mistry The Indian Express (P) Ltd. 3rd Floor, Sambhav House, Near Judges Bunglows, Bodakdev, Ahmedabad - 380 015 Mobile: +91 9586424033 Email Id: nirav.mistry@expressindia.com

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

clinical purposes. As a biological physiological medication, donor skin grafts can promote re-epithelisation, shorten healing time, alleviate pain and protect dermal and subcutaneous structures such as cartilage, tendons, bones and nerves. Though a variety of dermal matrices and skin equivalents, both synthetic and semi-synthetic, are available for wound treatment, viable human skin allografts remain an important therapeutic choice for extensive deep burns and hard-to-heal wounds. In

With generating right awareness, skin banks will play vital role in saving lives such cases, viable skin allografts have significantly better clinical outcomes than unviable humanderived allografts or synthetic medications.

Skin banks At a skin bank, skins grafts are available at subsidised rates which are of excellent quality, processed according to all international standards and utilised by plastic surgeons and also general surgeons, and orthopaedics. The new skin is used for burns patients, skin loss, diabetic non-healing ulcers, etc. where they act as an excellent biological dressing preventing protein, body fluids loss, pain relief, mechanical protection, thus helping in early recovery and reducing mortality and morbidity. The demand for human-derived skin bio-products continues to be a reason for the existence of skin banks. Skin bank organisation is complex and requires continuous updating. Careful donor selection, thorough microbiological and serological donor screening for transmissible diseases and rigorous quality control during tissue preparation are necessary to minimise the risk of transmission of pathogenic agents. Skin

EXPRESS HEALTHCARE

April 2018

banks must also observe standardised reproducible procedures to ensure tissue traceability and biological safety in all phases of processing and to avoid new biological contamination. Constant training and periodic checks are needed to keep skin bank operators attentive and responsible. Finally, skin

banks should guarantee collection and storage of highly viable skin. A skin bank is similar to an eye bank. In India, at present, awareness about the concept of skin donation is poor. Despite doctors from various skin banks around different states are counselling relatives of patients who

breathe their last, not many are coming forward to donate the vital and the largest human organ. India records around 70 lakh burn injury cases annually and of which 1.4 lakh people die every year. With generating right awareness, skin banks will play vital role in saving lives. The bank is a boon for patients as

there is no blood group matching required in skin grafting. Anyone over 18 years, who does not have skin disease or infections, can donate skin. Masina Hospital, in a shot span of six months, has procured skin from more than 20 cadavers and almost half the procured skin has been utilised satisfactorily.

I N T E R V I E W

To ensure better delivery of care Dinesh Samudra, CEO, Director & Co-Founder, Dr Abhay Chopada, Director & Co-Founder and Nilesh Jain, Director & Co-Founder, CliniVantage, in an interaction with Express Healthcare, talks about how CliniVantage has been able to streamline processes and address the traditional challenges in the healthcare sector

What is your opinion on the future of healthcare technologies for India? There is only one doctor per 1,700 citizens in India, their unwillingness to work in the rural hinterland is another. Rural healthcare facilities have revealed poor infrastructure, non-availability of even the basics. Medical devices industry was at a nascent stage of development from 2000-12. The pharma industry received $10 billion of FDI whereas as this industry didn't even receive 2 per cent of it. The situation is problematic. The healthcare industry is getting patient-centric. Indiaâ&#x20AC;&#x2122;s HCIT is expected to be at $1.45 billion in 2018, with CAGR of 30 per cent YoY. The current care system relies on paper-records, which leads to inefficiencies and impacting the quality of treatment. Technologies like mobility, digitisation, cloud storage, big data and AI are changing the way care can be delivered and this is where Clinivantage makes a difference. Clinivantage Technology is used to streamline processes and address the traditional challenges. Some of the technologies that would shape the future of healthcare industry in India may be PaaS, IoA, instant device IoT integration and AI, ML, telemedicine like Clinivantage.

EXPRESS HEALTHCARE

April 2018

MR DINESH SAMUDRA

DR ABHAY CHOPADA

MR NILESH JAIN

CEO, Director & Co-Founder

Director & Co-Founder

What role AI and cognitive technologies will play to build a strong healthcare system for India? Complex Predictive ML with big data AI, Clinivantage can help with accurate diagnostics of patients. Telemedicine becomes a reality with data repositories and using big data analytics to deliver rapid and accurate diagnostics to the patients remotely and timely. Clinivantage AI and ML will help doctors diagnose and predict the likelihood of treatment success.Clinivantage makes healthcare providers smarter to ensure better delivery of care. Predictive analysis, with smart algorithms mine patient’s data set; complete with previous diagnoses, treatments or genetic information to provide better patientcentric outcomes. CliniVantage will help support doctors’ decisions. The doctor

will have more context to patients, easing the complex and intuitive nature of future care. This technology helps doctors in treatment and interpreting the qualitative signals and personalised nuances that patients reveals, making care more outcome focussed and hyper personal. How do you see the health technology market growing in India? Today, we go to a doctor when sick, more episodic. At Clinivantage, we see healthcare as a service where doctors, hospitals and payers are actively involved in your care and take on preventive intervention. CliniVantage makes this possible with IoT, DoT devices and other wearables, with access to real-time data, one day in near future making it possible to predict if the patient is likely to fall sick and, thus,

take measures. Thus, with access to data and analysis, health practitioners can practise remote monitoring in real time, which means with CliniVantage, providers can pre-analyse and take decisions faster. CliniVantage alerts immediate intervention need if glucose levels are problematic, or blood pressure or cardiac issues are analysed sending both caregiver and patient a message saying, “Alert! Doctor on the way!.” or evening sending a nurse home. CliniVantage will revolutionise patient-doctor relationships. Thus, the way healthcare practitioners deliver care will change and become more personalised and outcome focussed. What is your market share? We are a startup that is 15 months old,

with product launch about 3 months ago, given that we have tremendous traction with 5M consumers and 10 M 'structured' consumer records. What is your current turnover from the Indian market? This year the projected revenue is between $1.5M to 3M. You have recently had a global strategic partnerships. Tell us more about the partnership and how this will add value to your current business? We believe in scale through partnerships and creating an eco system that will help focus on the skills and leverage strengths of all partners in the value chain, including companies like IBM Global services, Hitachi , EDS, Edifecs, SAH Global, etc.

EXPRESS HEALTHCARE

April 2018

CliniVantage-rendering new momentum to healthcare ecosystem CliniVantage mobilises the entire healthcare ecosystem, making it work in tandem to provide better outcomes for patients and improved productivity helping deliver profitable care by providers. Nilesh Jain, Director & Co-Founder, CliniVantage, gives an insight

n early 2017, we announced that we are building a PaaS (Platform as a Service) product, that aimed to democratise innovation in healthcare by transformation of ideas into products and services. CliniVantage began its journey long before, than its actual inception. Between Abhay, Dinesh and I we talked, discussed and even tried to acquire a company to give us a jump start. But when such tries failed, we took matters in our own hands, and created a vision for an open PaaS (Platform as a Service) that integrates across all IoA (applications) and DoT - (Doctor of Things - connected devices). In excitement, I coined my own term - DoT, (Doctor of things) in line with the trends of current day craze for “connected things.” Thus, we embarked on a journey not knowing how this will shape up, with our own set of IoAs and DoTs. We began creating a customer-centric healthcare story, with a clear goal, delivering wellness 24x7 for 365 days a year. The startup that begun as an allied project took shape largely in reality. It hit us when we got our first customer who was willing to be a part of our MVP (Mobile Virtualization Platform?) product. We took a challenge, and decided we won't build an MVP, but instead will build a production ready solution, given our experience, domain knowledge and eagerness to be the best. We made a production ready PaaS for healthcare domain, with our own time, money and energy. We further launched a few months later to small fanfare and a handful of early customers. At the time, we made a conscious decision to try and self-fund this product as much as possible; i.e., we’ll use incoming revenue on it, and won’t take on an equity investment until we believed that the product risk was taken care of. In about a year later, we’ve reached that magical bootstrap nirvana of being across six countries, three major global partnerships with zero external funding and on a road to be profitable in FY 201819. I believe there are several factors that have contributed to this, our passion to build something from ground up, support from our customers and the urge to

EXPRESS HEALTHCARE

April 2018

(L-R) Nilesh Jain, Director & Co-Founder, CliniVantage with Devendra Fadnavis, Chief Minister, Maharashtra

revolutionise the healthcare space. Focussing on priorities, is exactly what helped us build software, hardware and get the right domain gist. Parkinson’s Law states, “Work expands to fill the time available for its completion”. This is exactly what we have experienced. We were never out of work and the pace of our growth didn't help. Although very exciting, but lots to do. At every stage, we questioned on priorities and delegation, soon we learnt that building the next generation of flagship bearers was important. We started hiring the best domain expertise. We are proud that not only our founders’ backgrounds are complimentary, but our team reflects the same. Encouraging our teams to challenge and push each other to give the best to our customers and effectively building world class products be it, hardware, software, integration and an open platform, have resulted from equal efforts in code and growth. Six months into the life of CliniVantage, we realised that focus on growth was as important as building of our products. So, we divided our concentration equally on growth and creation. We were about to disrupt our own processes, time and focus. This paid off immensely and we could effectively

expand our customer base and get traction with partners willing to position as the best solution and take us places. Our efforts in acquiring customers have worked well; we have several customers who believe in us and our capabilities to deliver. I credit this to our deep domain knowledge personalised experiences and ability to deliver on technology. Dinesh, Abhay and I personally reach out to customers regularly and ask them how they are doing and product feedback. We published a product road map, early on and asked our customers for their input and feedback; we treated them as co-creators, since they are the ones who enjoy using our product. Of course, this is very tricky balance between building some ‘me too’ and creating a disruptive technology that customer has not envisioned. We have set out to disrupt healthcare and how services are to be delivered, be customer centric and move from wellness to illness, this is easier said than done. Finally, we look forward to a new India where healthcare is wellness care. India has witnessed a surge in diseases capable of adversely affecting the health of its population. Rising prosperity has been marked by a “healthcare

burden” — a continuing rise in infectious diseases and a spurt in non-communicable or “lifestyle” diseases, which accounted for 60 per cent of all deaths in 2015, from 42 per cent in 2001-03. Healthcare sector is now well placed to undergo positive change at all stages of the process — prevention, diagnosis and treatment. Investments from the private sector and innovation from startups can bring in a positive change in such a burgeoning healthtech scene. Healthcare is becoming one of India’s largest sectors, both in terms of opportunities, scale and size. ‘Liberty, when it begins to take root, is a plant of rapid growth’ — George Washington When it comes to the possibilities of 'learning from history' there are doubtless many things we could aspire to learn. Some of those would be more practically useful, in terms of contributing to the normal and decent functioning of well-meaning societies. It is in these moments of decision that the destiny is shaped, repeated actions will form habits and habits will lead the transformation on harm reduction efforts towards a healthier and a tobacco free world helping save a BILLION Lives! .

Most valued healthcare technology platform enabling healthcare consumers, providers, investors payers & partners.

Connected Healthcare CliniVantage Healthcare Technologies is established by visionaries who have been associated with the healthcare domain and healthcare IT for more than 25 years. To enable safe, efficient, transparent, proactive, and affordable healthcare through use of technology & innovation. Clinivantage brings more momentum to the entire healthcare ecosystem, making it work in tandem to provide better outcomes for patients and improved productivity resulting in profitable care for providers.

EMR

HealthHuddle

PMS

OTIMS

HIS

MyLife

MySchedule

CliniVantage Healthcare Technologies Pvt.Ltd Head Office - UK: 20 Langland Drive Pinner Middlesex HA54SA, UK India Offices: Pune: Tulsi Green, Office 3, B/H- D-Mart, Baner Road, Nandan Prospera Rd, Laxman Nagar, Baner, Pune, Maharashtra 411045, Phone: +91 20 65103501 Mumbai: 63 BMC Ind. Estate, Worli, Mumbai, 400013 US Office: 380 Hamilton Ave, Unit 557,Palo Alto, Ca 94302

Malaysia: Unit 02-11, Level 2, Tower A Vertical Business Suites, Avenue 3 Bangsar South No 8 Jalan Kerinchi, 59200, Kuala Lumpur Email: info@clinivantage.com

(Partner Oﬃce)

HEALTHCARE SABHA 2018

ANEWPARADIGM IN INDIA'S PUBLIC HEALTH The two-day conference saw public health experts deliberate on strategies to eliminate barriers to increase efficiencies in delivering quality, reliable and equitable health services in India. Moreover, public health torchbearers from various states were also honoured at the Express Public Health Awards held concurrently

EXPRESS HEALTHCARE

April 2018

EXPRESS HEALTHCARE

April 2018

HEALTHCARE SABHA 2018 DAY 1

HEALTHCARE SABHA 2018

8th March 2018

INAUGURALCEREMONY

Inauguration ceremony Welcome address Chief Guest Address Keynote address: Contribution of Armed Forces towards public health Empowering women to enhance public health Maximising the benefits of PPPs Networking Tea Break PANEL DISCUSSION: Measuring the success of women health programmes in India Use of WHO ATC DDD methodology in procurement Use of tools of health technology assessment to prioritise health needs Advantages through

(L-R) PBN Prasad, Deputy Drugs Controller, CDSCO-West Zone, Government of India; Lt Gen CS Narayanan, VSM, PHS, Dy Chief (Medical) & Senior Colonel Commandant HQ, Integrated Defence Staff, Ministry of Defence, GoI; Brig Smita Devrani, Principal Matron Command Hospital, Pune; Dr Nilima A Kshirgar, National Chair, Clinical Pharmacology, Indian Council of Medical Research (ICMR), Govt of India; Pranav Chandna, Director Solutions (PPP, Design, Consulting, LSP) Philips -Indian, Subcontinent; and Viveka Roychowdhury, Editor, Express Healthcare

NLEM-based hospital formulary Problems to solutions through innovations: A case study by PGIMER, Chandigarh Networking Gala Dinner

EXPRESS HEALTHCARE

April 2018

Welcome Address

he third edition of Healthcare Sabha 2018 began with a welcome address by Prathiba Raju, Express Healthcare. She took the audience through the vision of the event and welcomed them to two days of knowledge sharing. The theme for this year’s Healthcare Sabha was India’s Public Health Change Strategy – Prioritise. Plan. Practise. She jogged the audience’s memory about the past two editions where public health experts had come together to share their insights on public health policy and its implementation, and went on to explain this year's agenda. The first edition was on ‘Universal Access to Equitable, Affordable and Quality Healthcare Services to All’ while the second edition focussed on ‘Co-creating a Manifesto for Healthy India.’ “As India’s public health ecosystem continues to evolve,” she stated, “the third edition of Healthcare Sabha invites public

Prathiba Raju, Special Correspondent, Express Healthcare

health leaders to work towards formulating a change strategy, built on three principles: Prioritise, Plan and Practise.” She pointed out that the central theme of the

event aims to explore and debate on how India can bring in a multi-disciplinary and holistic approach across the spectrum of public health.

Achieving Universal Health Coverage

fter an auspicious and positive beginning to Healthcare Sabha 2018 with a lamp lighting ceremony, PBN Prasad, Deputy Drugs Controller, CDSCO-West Zone, Government of India gave the Chief Guest address. He deliberated on various initiatives taken up by Government of India in terms to the national health programmes, particularly highlighting the National Health Protection Scheme (NHPS). He pointed out that NHPS evolved from National Health Policy 2017 and emphasised on various sectors from primary to tertiary care, strengthening regulatory framework, all to improve health safety aspects to achieve Universal Health Coverage (UHC). He highlighted on the need for a more cohe-

PBN Prasad, Deputy Drugs Controller, CDSCO-West Zone, Government of India

sive and collaborative approach to achieve UHC. He also opined that NHPS is a project which seeks to achieve this objective. In addition to the how NHPS will play an integral role in achieving UHC, he further listed down the many programmes initiated by the government. These initiatives are with regards to medical education, drug regulation, new medical devices which emphasises and gives leverage to the Make in India initiative. He particularly pointed out that the Jan Aaushadi scheme will result in bringing down the prices, increasing the utilisation of the procurement policies. This will help to improve transperancy, thus improving our drug regulation system.

Contribution of armed forces towards public health

very interesting and informative keynote address was delivered by Lt General CS Narayanan, VSM, PHS, Dy Chief (Medical) & Senior Colonel Commandant HQ, Integrated Defence Staff, Ministry of Defence, GoI, who spoke on the multi-faceted and significant role played by armed forces medical sources to improve and enhance public health. Through his presentation, he illustrated the difficulties faced in delivering healthcare to the army personnel who are deployed in the most crucial circumstances. He elaborated on their significant efforts towards various aspects of public healthcare; for instance health surveillance, immunisation, disaster management, first responders systems, managing aftermaths of calamities, improving medical preparedness in India, etc. The fact that they often have to do it in hostile conditions and difficult terrains made their work even more worthwhile. He also highlighted the contribution of armed forces in healthcare policy making as well. In addition, he briefed the audience about the historical background of the armed forces across nations and how the public healthcare system in the armed forces evolved. He mentioned about the involvement of armed forces in public healthcare around the globe and across centuries, citing examples of James Lindt, Sir Ronald Ross, Walter

Lt General CS Narayanan, VSM, PHS, Dy Chief (Medical) & Senior Colonel Commandant HQ, Integrated Defence Staff, Ministry of Defence, GoI

Reed along with the origins of the Red Cross and WHO. He threw light on the various programmes, one such example included the ship to shore telemedicine system comprising 112 ships. The telemedicine initiative was also presented to the president and received huge government support in taking it forward. He also mentioned that National Telemedicine day will be celebrated on March 24 in Army Hospital in Delhi. He further highlighted the contributions of AFMC stating it “being a cradle for teaching and research”.

Moreover, he added, “Due to our special status, the government grants armed some special powers. In the National Organ Transplant Act wherein the Director General Armed Forces has been given powers to frame policy for sharing organs anywhere in India which is otherwise state specific.” He further touched upon a few other aspects involving contributions to communicable diseases, non-communicable diseases, epidemic control, activities in education research, some aspects of national policy making and more.

Public healthcare delivery in context of the armed forces stretches far beyond the envelope of water, environment, vectors,vaccines and hygiene. More than what we do, where we do and how we do it is what that defines us In conclusion, he stated that armed forces strive to be leaders in national policy making and partner with various organisations. He added that, “Public healthcare delivery in context of the armed forces stretches far beyond the envelope of water, environment, vectors, vaccines and hygiene. More than what we do, where we do and how we do it is what that defines us. ”

EXPRESS HEALTHCARE

April 2018

HEALTHCARE SABHA 2018

Empowering women to enhance public health

n the occasion of Women’s Day, a special address was delivered by Brig Smita Devrani, Principal, Matron Command Hospital, Pune who took the stage to speak on the importance of empowering women to enhance public healthcare. She started by elaborating what empowering women entails and says, “Women empowerment refers to strengthening of the social, economic and educational powers of a women; it refers to an environment where there is no gender bias and have equal rights in community, society and workplace.” She highlighted that even though there seems to be acute shortage of women in public health, there are many pioneers in the nation whose work goes unnoticed. She cited example of Janaki Amaal who pursued scientific research and was awarded Padma Shri in 1957 for her contribution to public health, among other examples, to emphasise the relation between women and public health. She highlighted that gender bias and

Brig Smita Devrani, Principal Matron, Command Hospital, Pune

under-representation of women in public health is detrimental to its progress. Adding to the hurdles, she pointed out a few other challenges such as humongous population, poor infrastructure make the public health scenario even more

grave. As a result, she suggested, “There should be a platform for healthcare domain experts, stakeholders, key participants to come together, as no single entity can work in isolation. Grass root workers, ASHA workers, family health

welfare and anganwadi workers are all empowered women who can act like potential catalysts. There should be an increase in workforce to bridge the gap and providing incentives would promote encouragement. Training women for newer technologies and giving autonomy to the health workers will also promote better healthcare delivery.” She also elaborated on her organisation’s role in improving public healthcare in the country and their myriad initiatives in this direction. A few of the initiatives she mentioned were Army Wives Welfare Association (AWWA), Station Health Organisation owned by the Department of Preventive and Social medicines, College of Nursing and Millitary Nursing Services which promote public healthcare. Concluding her presentation, she urged that women empowerment is vital in sustainable development of a nation. Creating awareness and keeping the women in public health motivated will help achieve the goal.

Future of PPPs in India

ranav Chandna, Director, Solutions, (PPP, Design, Consulting, LSP) – Philips -Indian subcontinent spoke on the future of PPPs in India. He started by elaborating on Philips’ offerings in this arena. Based on the company’s experience, he shared ways through which advantages of PPP can be maximised in healthcare delivery. He highlighted that PPP in India is not a new way of working, rather it is a well accepted model. Currently, we have established PPP units in government, we have new sources of funds and we are using PPP as an extension of multiple markets and sectors. He pointed out that earlier PPP models were used more in the core infrastructure, but as health is taking a priority, social infrastructure - be it health or education- is going to be administered in a big way through PPP. He stated the different roles played by both private and the public sector and suggested that the best solution to overcome the shortcoming is through PPPs. After speaking about the enablers, he threw light on some constraints associated with PPP, which create difficulty for private

EXPRESS HEALTHCARE

April 2018

There are five pillars for a successful, scalable and sustainable PPP model i,e.financial viability,bidder selection,quality, contract,and technology Pranav Chandna, Director, Solutions, (PPP, Design, Consulting, LSP) – Philips -Indian subcontinent

partners to enter the space. He mentioned that the time required for approval is highly detrimental for the private sector, the bank ability and self sustainability off these projects are also major constraints. He added that delay in payments from the government authorities as well as contractual confusions are present. Another issue is the medico-legal

liabilities and litigations, which needs to be resolved so that there is an increase in participation. He opined on the role of effective PPPs in driving public healthcare reforms in the country. He also spoke on the factors that come into play while formulation of policies to create a successful PPP venture in healthcare. He identified that there are five pillars for a suc-

cessful, scalable and sustainable PPP model i,e. financial viability, bidder selection, quality, contract, technology. He stressed on ensuring transparent pricing and sustainable cash flows. He concluded by sharing Philips contribution to PPPs in India informing about the various partnerships across India.

HEALTHCARE SABHA 2018

Panel Discussion: Measuring the success of women health programmes in India

(L-R) Alok Vajpeyi, Director Programmes, Population Foundation of India;Shubhalakshmi Patwardhan, Director, Niramaya Health Foundation, Mumbai; Dr Prakasamma, Director, ANSWERS, Hyderabad; Dr Shelly Batra, Co-founder, Operation ASHA, Delhi; Brig Smita Devrani, Principal, Matron Command Hospital, Pune and Viveka Roychowdhury, Editor, Express Healthcare

n observance of Women’s Day, a panel discussion was held on the success of women health programmes in India. The moderator, Viveka Roychowdhury, Editor, Express Healthcare, set the context for the discussion by pointing out how pivotal it is to give adequate focus to women’s health to reform public healthcare in India. The panel comprised Brig Smita Devrani, Principal, Matron Command Hospital, Pune; Dr Prakasamma, Director, ANSWERS, Hyderabad; Shubhalakshmi Patwardhan, Director, Niramaya Health Foundation, Mumbai; Dr Shelly Batra, Co-founder, Operation ASHA, Delhi; Alok Vajpeyi, Director Programmes, Population Foundation of India (PHFI). Beginning the discussion by understanding the challenges faced by different health workers in the Indian healthcare system, Roychowdhury asked Devrani to share the most frustrating experiences faced during her career. In response, Devrani pointed out that the women they work for, tend to not prioritise their health, despite awareness camps and training sessions. Adding to it, Prakasamma highlighted the challenges that include lack of recognition by the government regarding the importance of antenatal and postnatal care and the need to improve maternal care, as important part of women’s health. Severe lack of midwives

EXPRESS HEALTHCARE

April 2018

in the nation is one of the major reason for lack of guidance through the crucial period of childbearing thus hampering care. She pointed out that women are the creators of future generations and protecting their health is essential to ensure continuity of the human race itself. She also spoke on the need to have trained mid-wives to ensure improved outcomes during childbirth. Going further, Patwardhan pointed yet another challenge faced while working for the health of women in the slums of Mumbai. She says women in India are intoxicated by three major issues- service to others, which seems to be the first priority, sacrifice and self denial; which in turn make health as the last priority for women. She urged that women need to get out of the sacrificial, self-denial mode to own their health and take the right decisions. The next panelist, Dr Batra highlighted how TB is one of the greatest

threats to women’s health in India and points out that women face a lot of stigma and are often ostracised if they are infected with TB. The major challenge is that even though there is a huge TB infrastructure including hospitals, diagnostic centres along with many TB specialists, the last mile connectivity is missing. She added that even though the treatment is available, it is not accessible to the poor people. She spoke on various measures taken up by her organisation, which can help tackle TB in women. She explained that in disadvantaged areas, the organisation has opened treatment centres in temples, mosques, gurudwaras, shops ets, so that people can get access to medicines even after working hours. They have hired local people as community health workers, especially women from disadvantaged backgrounds, as they are the force to reckon with. She further elaborated

KEY TAKEAWAYS ❖ Advocating to expand the basket of contraceptives and increase budgetary allocation for family planning will help women in making informed decisions ❖ Hiring local people as community health workers, especially women from disadvantaged backgrounds, as they are the force to reckon with will help improve the last mile connectivity ❖ Govt should recognise the importance of antenatal and postnatal care and the integral role it plays in women’s overall health

how her organisation uses E-compliance which uses finger printing at temples to track, monitor and ensure compliance as well adherence to TB treatment. Vajpeyi elaborated on educating women to help them do effective family planning. He also said that women’s health is the responsibility of men as well and they should take it up seriously. He highlighted that women must be able to access health services as well as make informed choices. He said that women should voluntarily access the contraceptive methods available in the market. Further, he elaborated how his organisation, PHFI, is working on these issues and advocating to bring it on the social and political agenda of the country. He explained that they have worked with governments as well as communities to empower them and are also advocating to expand the basket of contraceptives and increase budgetary allocation for family planning. Post the discussion, delegates added a few valid points. One delegate highlighted that women's health cannot be take into account in an isolated manner as only a medical problem, rather it is more of a social problem. He elaborated that education to girl child is extremely important as well as the informing the elder women of the family will aid in providing all-round wellbeing.

Use of WHO ATC DDD methodologyin procurement

r Nilima Kshirsagar, National Chair, Clinical Pharmacology, ICMR, GoI, deliberated on access to medicines. In her presentation, she reinforced the need for rational use of medicines and procurement of medicines for universal coverage, highlighting the issues relating to access to health, many issues ranging from regulations to drug approval processes. She pointed out, “If you look at both national as well as global data, 50 per cent of the medicines are either prescribed, dispensed or sold inappropriately, and even the majority of patients fail to comply.” She added, “Most of the medicines are either overused, underused or incorrectly used, which results in serious morbidity and mortality.” The decision making related to prescription made by the doctors leads to grave issues for diseases like TB and AMR. She pointed out that NLEM list has been prepared by the Government of India

Dr Nilima Kshirsagar, National Chair, Clinical Pharmacology, ICMR, GoI

and updated in 2017, along with standard treatment guidelines which are published by the government and ICMR, but there are still measures to be taken to ensure

that medicines are provided to patients at public health facilities. Identifying that medicines form at least 10 per cent of the budget of any particular state, she ex-

plains about the procurement process. She states that the quantity of medicine to be procured increases by 10 per cent in comparison to the last year which still means that there is a shortage or surplus. She suggests that there is a need to plan the strategy and assess the budget involved in procurement. One example to set the priority right during in procurement is by using WHO Anatomical Therapeutic Classification (ATC) Defined Daily Dose (DDD) methodology. She cited a few examples of the medicines that have been procured less as opposed to the ones that have been procured in abundance which leads to misuse of funds, thus suggesting a need for formulation of proper policies. She further highlighted various malpractices and shortcomings in our current systems and urged the public health officials to put an effective strategy in place to mitigate them. She said we are still taking baby steps to universal access to the medicines.

Use of health tech assessment tools to prioritise health needs

trategies to implement best practices, innovation in procurement in public health were presented through two cases studies. Dr Suresh Saravdekar, Consultant – Procurement of Medicines & Medical Devices, IMS BHU, presented the first one and elaborated on the use of tools of health technology assessment to prioritise health needs. He started his presentation by saying that prioritising in public health is essential in these times when new medicines and new medical devices are cropping up, but the sector is facing a scarcity of government funds. He pointed out that in a market-based economy, prioritisation of healthcare technology is based on market creation and not on actual health needs, thus creating artificial needs. He also opined that in a market-based economy almost all innovations are targeted towards fulfilling the needs of rich countries, which in turn create global concentration and dominance of a few nations and top companies. He added that in the last 50 years, hardly any new drugs have been invented to target diseases like TB, dengue and malaria which are prevalent in poor countries. Elaborating on the new drugs, he said, “According to USFDA, only 14

Dr Suresh Sarvdekar, Consultant – Procurement of Medicines & Medical devices, IMS-BHU

per cent drugs are innovative and rest are similar to the existing ones.” Drawing inferences from a Lancet study in 2017, he spoke on the findings of prioritisation of the market based healthcare scenario. The study informs that even though life expectancy has increased substantially, healthy life expectancy has not increased much. He reiterated that there are a few tools which can be put to use to enable appropriate prioritisation of health needs with

optimisation of funds. These tools are called Health Technology Assessment tools which aid in prioritising the technological needs of the hospital. He pointed out that they are currently used for only budgetary evaluations, and explained how it is different from economic evaluation. He gave a list of the tools that are available and shared case studies alongwith the procedure of how these tools aid in analysing the different medicines that are available.

In healthcare services,the allocation of funds, while introducing new technologies should be subjected to not merely budgetary evaluation but also proper economic evaluation He concluded by saying that in healthcare services, allocation of funds, while introducing new technologies should be subjected to not merely budgetary evaluation but also proper economic evaluation. He concluded by saying that the health technology assessment tools, when put to use, will help produce credible and standardised information that is relevant in decision making.

EXPRESS HEALTHCARE

April 2018

HEALTHCARE SABHA 2018

Advantages through NLEM- based hospital formulary

resenting a case study, Dr Om Upadhyay, Medical Superintendent, Sir Sunderlal Hospital, Banaras Hindu University, UP, highlighted about the list of essential medicines that are defined by WHO to make medicines available, affordable and accessible to the masses. He said that we should have mechanisms and technologies that can create a healthy market place which enables competetive pricing. He gave a brief history of how the list of essential medicines was generated. Further, he informed that the list is updated every two years and expounded its role in achieving Universal Health Coverage. He informed that the commission responsible for NLEM has identified five areas that are crucial to essential medical policies such as making essential medicines affordable, ensuring quality and safety of medicines, promoting quality use of medicines, developing missing essential medicines and bringing in accountability of all stakeholders to achieve UHC. Going forward, he elaborated on his organisation's drug policy and highlighted its measures to reduce the cost of medicines. He also praised governmentâ&#x20AC;&#x2122;s schemes such as Umang and Amrit.

Dr Om Upadhyay, Medical Superintendent, Sir Sunderlal Hospital, Banaras Hindu University, UP

He shared their action plan for the formation of a hospital formulary committee. The committee comprises Head of Medicine, Senior Professors from medicine, surgery and pharmacology, along with consultants and pharmacists. He went on to explain the functions of the committee to streamline medicine procurement procedure in terms of proper selection of medicines and central tendering eprocurement of of quality medicines. He said that as far as the tendering procedure is concerned, the hospital

applies certain qualifications/conditions for the applicant of the tender. The second function of the committee includes reformatory measures to promote rational and proper use of medicines by clinicians, pharmacists and nurses. He suggested that there is a need for monograms on proper use, dosage, precautions, side-effects, adverse effects, generic names, name of the manufacturers with details etc. He also emphasised on the role of a formulary in monitoring prices and implementing cost-effective measures.

The commission identified five areas, crucial to essential medical policiesmaking essential medicines affordable,ensuring quality and safety of medicines, promoting quality use of medicines, developing missing essential medicines, accountability of all stakeholders to achieve UHC He also informed how NLEM will help in streamlining the process and ensuring quality medicines to the patients.

Problems to solutions through innovations

r Shweta Talati, Assistant Professor, PGIMER, began her session by referring to Healthcare Sabha's agenda, India's public health change strategy: Prioritise, Plan, Practise. She pointed out that amongst the three, putting plans to practice is the most difficult one. Presenting two examples from PGIMER, Chandigarh, she showcased how it seeks solutions through innovations. In the first one, she pointed out that the average length of stay in a hospital is a sensitive indicator and high average length of stay leads to hospital acquired infections, needless suffering of the patients and inefficient utilisation of hospital resources. Therefore PGIMER has installed a Decision Support System, a technology embedded in the existing hospital information system. The pro-

EXPRESS HEALTHCARE

April 2018

Dr Shweta Talati, Assistant Professor, PGIMER, Chandigarh

gramme sends emails and messages to notify consultants if patients have exceeded the average length of stay at the hospital. This helps in monitoring care and its impact includes treatment of more patients with the same number of sanctioned bed strength. She said that due to this technology, the institute was able to treat 3.57 per cent more patients during 2016 than 2015, and 6.2 per cent more patients in 2017. Her second case study was on effective handling of medico-legal issues. in the public and private sectors. Pointing out that they are usually a tedious and a time consuming task, she threw light on how using technologies like video conferencing makes it easier. She concluded by saying that technology is revolutionising healthcare.

DAY 2

HEALTHCARE SABHA 2018 Good governance in public health: Learnings from Mission Indradhanush; Dr Pradeep Haldar, Deputy Commissioner

9th March 2018

Good governance in public health: Learnings from Mission Indradhanush

(Immunization), MoH&FW Stroke management in public health; Dr NR Ichaporia, Consultant Neurologist, Jehangir Hospital, Pune Tea Break PANEL DISCUSSION: Reviewing the role of states in public health CASE STUDY: Operationalisation of SNUs; SN Bhure, Mission Director, NHM, MoH&FW, Government of Chhattisgarh CASE STUDY: Initiatives for change at Central Hospital; Dr Rupa Mitra,Medical Director, Central Hospital, South Eastern Railway & Dr Anjana Malhotra, Addl Chief Health Director, South Eastern Railway CASE STUDY: Financing Public health; Devbrat Ohri, Sr vice president and Head of Govt Operations, Medi Assist Role of health insurance in India; KB Vijay Srinivas, GM, National Insurance

Dr Pradeep Haldar, Deputy Commissioner (Immunisation), Ministry of Health and Family Welfare (MoH&FW)

Company 12.35 pm - 01.30 pm Networking Lunch 01.30 pm - 02.15 pm Panel discussion: The Way Forward for NHPS CASE STUDY: Hridyam for little hearts; Keshavendra Kumar , Mission Director, Kerala Good Governance with Digital Technologies; Dr Prashant Paunipagar, Dean, ESIC Medical College, Gulbarga. Express Public Healthcare Awards Nite

r Pradeep Haldar, Deputy Commissioner (Immunisation), Ministry of Health and Family Welfare (MoH&FW) set the tone for the second day’s sessions at Healthcare Sabha 2018 with a very informative keynote address, on the topic ‘Good governance in public health: Learnings from Mission Indradhanush’. He discussed on various steps taken by the Union Health Ministry to implement the Intensified Mission Indradhanush (IMI) coverage in India. Giving a detailed overview on how the Union Health Ministry shaped the IMI, Haldar said, “In 2015 after four rounds of vaccination under the Mission Indradhanush programme, 2.55 crore children were vaccinated ie 68.79 per cent got vaccinated, which was seen as a slow progress. So, the ministry initiated IMI, which was launched by the honourable Prime Minister to accelerate the full immunisation coverage across the country and provide greater focus on areas, which had low immunisation coverage. Under IMI greater focus is given on urban areas as there was less coverage during Mission Indradhanush. At the end of this IMI, almost 59.46 lakh children were vaccinated and 14 lakh children were fully immunised which is around 75 per cent.”

Informing that IMI was an apt example for good governance, Haldar said, “IMI can be showcased as a good example of good governance in public health. With this mission the Union Health Ministry focussed and incentivised monitoring and established strong accountability right from national level to state and community health level. We wrote to all the chief ministers at state level to review the preparations and progress of vaccination. There was convergence under NULM with other union ministries, departments especially women and child development, panchayati raj, urban development and also community health workers NCC and NYK cadets in order to execute the programme effectively. There was a high level of political commitment, which helped us to successfully implement the IMI programme.” Answering to a question on the Adverse Effects Following Immunisation (AEFI) cases, Haldar said, “We are strengthening the AEFI services, we investigate each of the case. We are publishing the data on AEFI case in MoH&FW website.” Haldar also highlighted that IMI was an example for a well-executed government programme, the way forward is to strengthen IMI and sustain it.

EXPRESS HEALTHCARE

April 2018

HEALTHCARE SABHA 2018

Stroke management in India

r NR Ichaporia, HOD-Department of Neurology, Jehangir Hospital Pune, spoke about stroke management and how public health workers can save lives of several patients at the golden hour. He began by explaining how a paralytic brain stroke occurs and went on to say that very few people in India know what is a brain stroke. “People are very much aware of heart attack but they are less aware of brain stroke; therefore, it is important to term it as brain attack rather than stroke. In this case, brain cells die and cannot be revived. And these have very serious consequences. Among the noncommunicable diseases, brain stroke is the third common killer in India after cancer and heart attack. Around 7.5 lakh people die in India every year due to brain stroke. One in five or one in six people will suffer a stroke which means every Indian family will have at least one stroke patient. In India we have 30004000 strokes everyday and last year we treated 13,500 patients using thrombosis. What is worry is that, most stroke

Dr NR Ichaporia, HOD-Department of Neurology, Jehangir Hospital Pune

patients in India are in their prime of life, which means a huge economic loss to the nation. But the good news is that there is a growth rate of around 30 per cent in treatment of stroke each year. Now in order to further this growth, we need the help of physicians”, he stated. Dr Ichaporia then informed that a

large number of people suffering from stroke do not get the medical aid that they require and have poor access to healthcare services. Statistics show that last year around 136,000 patients did not go to the hospital at all and even if some patients go to the hospital the type of treatment that they received was poor.

He further urged the audience to understand the criticality of the situation and informed that there is a need to upgrade our ambulance services. “Luckily, we are getting systematic with the 108 ambulance service. However, it is important to note that most among these patients are not transported to the right hospital. Hence, there is a need to equipment government hospitals with treatment facilities or make them stroke ready. It is important for hospitals to understand that stoke management means time. One large stroke ages the person for about 36 years older. So a 50-year-old man in 12 hours will become a 86-yearold man. That is the intensity of stroke and that's why time play a significant role in its management”, he added. At the end, Dr Ichaporia stressed upon the need for a team effort for stroke management in India. He reminded the four main elements to stroke management — effective bed sores treatment, DVT prophylaxis, checking for swallowing issues among patients and keeping the temperature low.

Operationalisation of SNCUs

r SN Bhure, NHM Mission Director, Chhattisgarh presented a case study on a strategic approach to quality mother and child healthcare by operationalising the SNCUs within the state. Dr Bhure began by informing the audience about the challenges they have faced in providing healthcare services in some remote areas of Chhattisgarh. He informed that there are around 6-7 lakh births every year in their state, out of which around 3.5 lakh deliveries are taken place in government hospitals. Nearly 15 per cent of these babies need early child care, that required around 1200 SNCU beds. After giving a background to how the state initiated this programme, he informed that this programme is executed by striking partnerships, where the state became the lead financial source to this programme. They roped in a Chennai based NGO- EKAM Foundation whose vision was in line with the vision of the state. “This NGO is doing a great job in the management of SNCUs. We have also roped in our medical college and our new AIIMS to make this programme effec-

EXPRESS HEALTHCARE

April 2018

Dr SN Bhure, NHM Mission Director, Chhattisgarh

tive and successful.” Speaking about the progress of the programme, Dr Bhure said, “We started off with this programme in 2013 and today we have 18 SNCUs and by the end of this year we will have 25 SNCUs. With the help of the NGO, we are able to generate specialised nurses to care for these

new borns. We are now having NGO admission of around 18,000. Today, we also have an online system that tracks the progress of our SNCUs. The results of which show that we have 115 per cent occupancy. There is a declining trend in mortality in new borns due to the operationalisation of the SNCUs. We are also

trying to increase efficiency among our doctors, nurses and paramedic staff.” Talking about their strategy for success, he went on, “Initially, we did not have an human resource department to deal with the shortage of talent to provide care at these SNCUs. Striking a partnership with EKAM has helped us to fix this issue. They took charge of the recruitment process and even helped us develop a department for us in the state. Today, HR department trains public health workers from other states as well. We have also engaged EKAM Foundation in the medical equipment management as SNCUs is very capital intensive unit and therefore it is imperative for an efficient equipment management and maintainence system. Another interesting aspect that we introduced was the micro-biological surveillance of all SNCUs and have developed a SOP for logistic management. We also look at aspects such as power and safety etc. All this has increased operational efficiency among our SNCUs, thereby leading to better new born child care in our state.”

Reviewing the role of states

(L to R) Dr Dev Varma, Dr Rakesh Kumar Srivastava, Dr Sarveshwar Narendra Bhure and Dr K Rajo Singh

cientific advancement in healthcare has allowed human beings to double their life spans and effectively address life-threatening diseases such as malaria, cholera and plague that have in the past wiped out several civilisations. India in this direction has done well in addressing some lethal diseases and improved health indices but this achievement would not be possible without the strong support of the states. The states have shaped India’s health system in many ways, determining and influencing key system components such as insurance coverage and ensuring quality of care. The panel discussion on 'Reviewing the role of states' brought to light some key learnings from the states of Chattisgarh, Manipur, Tripura and Rajasthan. The discussion also got the audience to share some learnings from states such as Arunachal Pradesh, Karnataka and more. Dr Rakesh Kumar Srivastava, Ex- Director General of Health Service, GoI, Advisor, WISH FOUNDATION was the moderator for the discussion who guided the panel to shares state specific innovations that each of them have come up with and good practices that they follow. The other panelists were Dr Dev Varma, Director of Health services & Ex-Officio, Add Sect, Govt of Tripura, Dr K Rajo Singh, Director of Health Services, Govt of Manipur and Dr Sarveshwar Narendra Bhure, Mission Director (NHM), Government of Chhattisgarh. During the discussion, panelists spoke on the programmes and practices

they follow that cover aspects such as efficient financing models, good governance, proper utilisation of funds, improving infrastructure and capacity building and addressing talent crunch. Dr Varma began by giving a brief about the number of health centres and government hospitals in the state of Tripura. He also threw light on the lack of trained manpower in his state. “You will be suprised that we do not have a neuro surgeon at our trauma centre and therefore, we call this it the trauma care centre,” he miffed. He continued talking about manpower crunch in the state and informed about the two new medical colleages that have been established in order to resolve this issue. He also hightlighted their health financing scheme and said that it is a model which can be replicated by other states as well. He also spoke on the lack of quality healthcare services in the state so far and how the state government is currently, trying to improve quality. Dr Singh gave a background of the state of healthcare in his state of Manipur. He spoke of all the difficulties they face in providing healthcare services to their

people. There were no trauma centres in the state untill recent times. They are now establishing two to three trauma centres. “Despite several difficulties that we face, we are trying our best to provide appropriate care to our patients. We are also providing medical and health insurance. We have recently introduced the Chief Minister’s health Protection scheme and are hopeful to better our health services using this scheme”. Adding to this, Dr Srivastava pointed out that Indian states need innovative public health delivery mechanisms that can be replicable and scalable. Dr Bhure looked at present healthcare situation in India in a positive light. He said that our challenges needs to be turned into opportunities for making India a better healthcare provider. He went on to say, “In the last 71 years after India’s independence, our nation has done well in improving the state of healthcare. We need to acknowledge the kind of effort the government has put in, to provide health services to the citizens. Having said that, we still have a long way to go.” He also spoke on the SDGs for healthcare set by WHO and highlighted that

KEY TAKEAWAYS ❖ India needs a strong health financing scheme ❖ Indian states need innovative public health delivery mechanisms that can be replicable and scalable ❖ Role of the private healthcare sector and the pharmaceutical industry in improving accessibility and affordability of healthcare in India is crucial ❖ NHPS can bridge the gaps in public health

India still needs to work towards achieving them. “We needs a strong public health financing system for the country”, he maintained. Further, he highlighted that states which spend significantly on health also have better health indices and medical outcomes. “There is a clear rural-urban divide when it comes to healthcare services, which needs to addressed. There is huge disparity in terms of health services in the rural areas. The government needs to focus on accessibility in rural areas first and in urban areas, the government needs to focus on affordability. With the introduction of the NHPS, we hope to bridge the gaps in public health as well”, he mentioned. Bhure also spoke about the crucial role of the private healthcare sector and the pharmaceutical industry in improving accessibility and affordability of healthcare in India. Moving forward, Dr Srivastava, presented his view as a public health worker and cited examples on innovative solutions from the state of Rajasthan. The solutions were around creating a strong supply chain management system and on increasing accessibility through developing subcentres for health services. He also informed that states such as Haryana, Madhya Pradesh and Chattisgarh have already started working on the system to create sub-centres. The panel discussion was followed by a Q&A session where delegates raised questions related to proper utilisation of funds, governance of health programmes and manpower shortage.

EXPRESS HEALTHCARE

April 2018

HEALTHCARE SABHA 2018

Railwayhospitals’contributions to public health

r Rupa Mitra, Medical Director, Central Hospital, South Eastern Railway and Dr Anjana Malhotra, Addl Chief Health Director, South Eastern Railway, Burn Intensive Care Unit Initiative at Central Hospital presented a case study on the strategies utilised by Central Hospital to improve operational efficiency and patient satisfaction. Dr Mitra began by briefing the audience about the overall functioning of the railway hospitals in India. She informed that the railways has 17 zones and each zone has a referral zone. Central Hospital, South Eastern Railway is one among these zone and is a premium tertiary care centre. The centre is a referral hospital for the zone but a referral hospital for, Eastern-Metro, North East Frontier and East Coast railways. The hospital specialises in burns, plastic surgery, oncosurgery, nephrology, cochlear implants and ophthalmology. After giving a brief on the services that the centre provides she mentioned the vision of the hospitals that speaks of continuous quality improvement and patient satisfaction. She further spoke on how the hospital has embarked upon achieving its goals for quality and patient satisfaction in the last three years. She said, “ In the last three years, we have setup a state-of-the-art burns unit, introduced three modular operation theatre and set-up a modernised surgical ICU. In

Dr Rupa Mitra, Medical Director, Central Hospital, South Eastern Railway

Dr Anjana Malhotra, Addl. Chief Health Director, South Eastern Railway

the pipeline are proper central sterile supply department, 12-bedded medical unit and revamping of the medical gas pipeline

of the hospital so that the we can maintain quality and that every bed in the hospital will have a oxygen suction airway. We

have also come with an antibiotic policy for the hospital. Dr Malhotra, further, spoke on their specialised burn unit and how it has become a differentiator for the railway hospital. She said that in India most of the burn patients have to go to government hospitals and very sadly there are few government hospitals that specialise in its treatment. Therefore, burn management is an important area of focus in public health, she informed. Dr Malhotra, shared information on how they have set-up state-of-the-art burns unit. “We have being trying to spread awareness on the fact that when a person experiences burns, the first thing that needs to be done is to pour water on the burn area and not cover with a blanket.” At their hospital they have set-up a hydrotherapy centre which becomes the first step towards treatment. Then they ensure that patients receive a non-crystalline silver dressing which can be used for around 72 hours. This reduces the cost of treatment as well as provides high quality infection free dressing. She then urged the audience to opt for re-burn wound excision for better burns management and to reduce mortality. At the end, she shared the outcomes of these improvements done by the hospital after upgrading the these facilities.

Good governance with digital technologies

r Prashant Paunipagar, Dean ESIC Medical College, Gulbarga spoke on how digital technologies can be implemented to foster good governance in public health and how this will act as a great contributor to the vision of the Digital India goal. Dr Paunipagar began by explaining what good governance truly means in healthcare. “Good governance is concerned with deliverance of sound economy and developmental policies in a factual manner to the people,” he said. He then spoke on the digital technologies utilised at ESCI. He informed that at ESCI hospitals, they use the following digital technologies to enhance patient care, whats app, official website to maintain transparency, e mail services, Dhanvantri portal, hands on training and more which gives impetus to their gover-

EXPRESS HEALTHCARE

April 2018

Dr Prashant Paunipagar, Dean ESIC Medical College, Gulbarga

nance activity. He further gave an example of how they created a system backed by digital technologies at their Gulbarga ESCI hospital and how they achieved excellent outcomes out of this project.

Dr Paunipagar disclosed that they have created some official Whatsapp group for immediate communications. One among these is the Swacch Bharat Abhiyan group, which keeps a constant

information flow on the updates on cleanliness and hygiene related communication among the college and hospital staff that helps to maintain the highest levels of cleanliness. Additionally, the ESIC website is also very dynamic and provides information on the tender process, recruitment details, academic details, administrative details and more. The Dhanvantri portal system is a unique online system that monitors every action within the hospital right from patient entry to its recovery process. “Upgrading our college and hospital system with digital technologies have helped us in many ways. It has enhanced good governance within our hospitals and helped us provide better care to our patients. Our vision to is digitalise our data system and increase operational excellence,” he summed up.

Manipur’s health protection scheme

evbrat Ohri, Senior VP- Government Oprations, Medi Assist, presented a case study on Manipur’s health scheme. He began with talking about the challenges North Eastern states face in providing health services to their people. In the light of the fact, that these states have difficult terrains and are also overlooked by the government in many ways, he said that the state of Manipur spreads around 22,000 sq kilometres and has a population of about 30 lakhs, but the state has only two multispeciality hospitals, both being government hospitals and there is a serious lack of health infrastructure. He also explained the healthcare cost dynamic within the state. The health funds allotted to the state is meagre, he informed. He also drew comparisons on the cost of child delivery in the state which is an average of approximately ` 1500 for a normal delivery in a government set up as compared to other states which have lower rates. Therefore, an all encompassing health protection scheme

Devbrat Ohri, Senior VP- Government Oprations, Medi Assist

becomes very significant in this state. Ohri explained the health protection scheme that the state offers and informed about the striking features of this programme. “We wanted to provide a comprehen-

sive scheme to the people so we created a technology platform and integrated the Jan Aushadhi (656 drugs), the NHM free medical services scheme along with our health scheme. Initially anything that was not available within the state, we had to

send patients outside. So, integrating these three things we created a Rogi Kalyan Samiti account where government hospitals were asked to provide this treatment, along with providing medicines from the Jan Aushadhi and diagnostics from a vendor with whom the government has negotiated on the lower price for its services. With this, we realised that the cost of health services came down to almost 30-40 per cent. So, with the 30-40 per cent of the cost saved, the state intends to effectively utilise these funds to upgrade the infrastructure and services, to ensure that the poorest of the poor get treatment at the CHCs, PHCs, district medical hospitals and regional medical centres. The vision is to provide greater care to a large number of people using the government services. He also later pointed out that the state still faces some challenges in reaching out to extremely remote areas but they are working on building a system where they can get these people also under the care territory.

Role of health insurance in India

B Vijay Shrinivas, GM, National Insurance Company started off by giving a background on the work the National Insurance Company does in the field for healthcare. He highlighted the statistic on GDP spending and health outlay in India. He said that India's contribution on health is below countries like Indonesia and Bangladesh and slightly better than Myanmar. Shrinivas, pointed out on the lack of manpower and capacity of hospital beds and said that there is a huge opportunity for healthcare providers from the private sector as well as government to bridge this gap. After expounding on the current scenario and the need of the hour to strengthen India's healthcare system, he went on to say, “I have always felt that we are being talking about healthcare, but it is not healthcare, it is ailment care. Health is nowhere in the picture. Nobody wants to talk about good health. They want to talk about ailments because that's where money is. So, we need to change the focus for ailment care to healthcare. Infact, I strongly believe that Baba Ramdev has contributed more to healthcare, than hospitals. Hospitals should be just one portion of the entire gamut of healthcare, but

Nobody wants to talk about good health.They want to talk about ailments because that's where money is

KB Vijay Shrinivas, GM, National Insurance Company

that has acquired preeminence. They is no money in telling a person to go for a morning walk everyday. Perhaps, that motivation is missing to focus on good health.” Moving forward, he spoke on an initiative that they have started which involves a summit and where they intend to connect wellness with health insurance.

“Currently, health insurance is also ailment insurance and therefore, we have tried to integrate both. Across the world, there is a wide spectrum of models for healthcare or ailment care- from one end of the spectrum where the government leaves each citizen to take care of themselves and the other where the government takes responsibil-

ity of the people’s health. In between, there are models where the government funds the people and the private providers offer health services. All this cost money. One way of accruing the cost is from tax revenues. In India, we are seeing an increasing trend of tax revenues being utilised for funding health programmes. Second is out-of-pocket, which is major issue in India and third is insurance.” After explaining how insurance can play a key role to bring down costs, he says that NHPS can be another game changer for India.

EXPRESS HEALTHCARE

April 2018

HEALTHCARE SABHA 2018

NHPS: The wayforward

(L-R) KB Vijay Shrinivas, Dr Prateek Rathi, Bejon Misra, Dr Raju Sukumaran

he Union Budget announcement of the launch of the National Health Protection Scheme (NHPS) by the Finance Minister Arun Jaitley this year has left healthcare experts, economists, analysts, healthcare critics and media contemplating on the prospects of the scheme and its economic impact on the nation. While most of the industry players both in the private sector and government seem to be upbeat of this initiative as they see huge opportunities for improving the healthcare system, there are few who are skeptical of its implementation and influence on the system in the long run. Healthcare Sabha's panel discussion on 'The way forward for NHPS' deliberated on how this scheme can be beneficial from the healthcare provider and patient point of view. The panelists for this discussion were, Moderator: Dr Prateek Rathi, Special officer, ESCI, Govt of Maharashtra, Bejon Misra, International Consumer Policy Expert and The Partnership for Safe Medicines (PSM) India, Dr Raju Sukumaran, State Medical officer, MoH&FW, Government of Kerala and KB Vijay Shrinivas, GM, National Insurance Company. Dr Rathi began the discussion by giving a brief about the ambitious plan under the NHPS and the doubts surrounding the implementation. He highlighted the key factors, such as costs involved, the burden of medical impoverishment, role of states in the execution of the scheme, issues of supply, moral hazard, etc., that are essential for the successful implementation and sustainability of NHPS.

EXPRESS HEALTHCARE

April 2018

Misra explained his view on NHPS and how it will be a game changer for the sector. He also said whether the government’s move from a provider to a purchasers will work for India or not. He said, “The NHPS will serve as an institutional scheme in our healthcare system, where there will be no differentiation between public and private. We have been listening to people saying that healthcare services is for free several times, but nothing is for free. Healthcare costs are either paid by the tax payers' money or by people themselves. I feel that the NHPS will bring a sea change in the insurance sector of our country. IRDA cant sleep any longer. They will have to ensure transparency in insurance dealings.” He then asked the audience whether they knew about the functioning of reassurance companies. He then informed the audience on how the reassurance companies function and said, “The NHPS will empower the patients to decide where they would like to avail their healthcare services. This will allow the patient to choose whether they want to go to a private healthcare provider or a public healthcare provider and the government will pay for the same.” He firmly said that NHPS will be a

catalyst for pitting the public and private sector against each other in order to provide better healthcare services to the people. This will, in turn, only better our healthcare system as competition drive better quality and brings in affordability. Misra's point on the availability of choice for patients was well taken by the audience and the panelists. However, Dr Rathi pointed out that India has a very poor legal system and regulations for healthcare. In such a scenario, how much availability of choice will be possible and how can we ensure that this will not lead to exploitation of patients, he questioned, Misra. On this, Misra replied saying, “Here technology will play a very big role. Data will be collected in realtime. All records will be cloud-based. Corruption will be curbed. We have to ensure that at least in healthcare, there cannot be any fraud or manipulation.” Dr Rathi then, asked Shrinivas to speak on the cost factor of NHPS. Shrinivas drew parallels between the cost analysis of RSBY scheme, NHPS and the Pradhan Mantri Fasal Bima Yojana (PMFBY). “There has been a wide range of difference in cost and it is completely related the market dynamics at the moment,”

KEY TAKEAWAYS ❖ NHPS will empower the patients ❖ Technology will play a key role in the effective implementation of this scheme ❖ The issue of moral hazard and how this leads to manipulation of healthcare cost needs to be addressed ❖ Transparency, talent utilisation should also be looked at while structuring NHPS

he informed. Dr Rathi further brought up the issue of moral hazard and how this leads to manipulation of healthcare cost in the public sector and budget utilisation. Shrinivas explained the analysis of how the cost curve is derived in any given public health scheme. He further pointed out that in the initial year of a health programme the cost incurred in a scheme is less, but as time passes by and people are more aware of the programme there is more utility and more addition to cost. Expounding further on the cost curve he said, “The reason why the graph only keep shooting high is because of the spiralling costs. What was available for ` 5-10, years back, is now available for ` 50 or ` 100. Be it cost of medicines,hospitalisation, doctor’s fees etc., and the moment a patient says that he/she is insured, there is malicious glow on the face of some healthcare providers. attitude of healthcare providers towards patients having health insurance. These are some aspects as to how all the cost keeps mounting each year. Well, moral hazards will continue to happen but technology as mentioned earlier will play a key role in bringing this down.” Dr Sukumaran shared his perspective on the role of states in the execution of the scheme. He also spoke about the challenges states face in their current schemes and the doubts they have regarding NHPS. The discussion was then open to the audience for questions. The audience raised questions related to transparency, talent utilisation and more.

Hridyam for little hearts

eshvendra Kumar- Mission,Director, NHM, MoH&FW, Government of Kerala started off by saying that ‘Hridyam - for little hearts’ programme initiated by the Kerala government to support children with Congenital Heart Disease (CHD), is a unique and innovative model that has successfully provided surgical care to a lot of children with CHD within the state. Kumar gave a background as to the reason why the government initiated this programme. He said Kerala is said have the lowest Infant Mortality Rate (IMR) in the country. Currently, the state has around 8-9 IMR and most of which are due to CHD that causes 25 per cent of the IMR and other infectious diseases. Therefore, the state decided to come up with a comprehensive treatment programme which will not only address CHDs among infants but will also bring down the IMR further. He informed, “Prior to this

Keshvendra Kumar- Mission,Director, NHM, MoH&FW, Government of Kerala

programme, only one government centre was offering CHD care for children. With the launch of this new programme, we have four centres that provide cardiac care to children. In future, we will be adding one to two

centres under Hridyam.” Kumar further explained on how Hridyam also has a good system for governance as well. Hridyam is a web based solution for system management of care of children. This can be

used as web-based registry for CHD cases across Kerala, monitoring the progress of programme envisaged for management of children with CHD, identifying the bottlenecks for implementing the protocols established at any point, understanding the case status and response time for systems in place and ultimately measuring the outcomes of the programme. “We have constantly being working on furthering the scale of this project. We have started empanelling private hospitals in this programme. So far, we have empanelled four hospitals to increase the capacity of our programme,” he added. Since the CHD needs continuous care, the government has also developed a follow-up system. The government has also ensured that through this programme, parents of new born babies get enough information of the disease. Also, the treatment provided to children with CHD is completely free.

Launch of be The Change Campaign

xpress Healthcare, launched a new initiative 'Be The Change' movement at the third edition of the Healthcare Sabha. The social movement, is an endeavour to encourage and motivate public health professionals to believe in themselves and do their bit towards driving public health reforms. The movement was launched by Bejon Misra, International Consumer Policy Expert and The Partnership for Safe Medicines (PSM) India. He was also the first to take the ‘#BeTheChange’ pledge. Mishra also urged other public health officials to take the pledge and accelerate progress in India’s public health system. Explaining about the vision and endeavour, to initiate the movement, Viveka Roychowdhury, Editor, Express Healthcare said, “We at Express Healthcare believe that it is time to ignite a movement in Public Health, one that faces head-on the pressing problems in providing affordable, accessible and reliable healthcare delivery services. Instead of waiting for change, can we in fact Be The Change?” Citing few example how to go about it, Roychowdhury said, “Can public health officials pledge to take up 1 project for this

Bejon Misra launched the Be The Change Campaign

year, 2018-19, that they would like to achieve which can yield measurable outcomes in the area under their jurisdiction? For instance, can the available funds and resources be utilised more effectively by thinking out of the box? How can technology be leveraged to monitor the compliance levels in difficult to treat conditions like TB? How can a department try to be more transparent?” Referring to one of the winners of the Express Public Health Awards 2017, Roy-

chowdhury said, “ Government of Andhra Pradesh bagged a award for the project NTR Vaidya Pariksha, which resulted in the reduction of out of pocket spend from 45 per cent to 17 per cent in one year, while allowing 46 lakh patients to avail of free diagnostic services in one year. These stated goals as project statements, will be documented and presented to the Ministry of Health and Family Welfare (MoHFW) as part of the Outcomes Report post this year’s Healthcare Sabha.

The social movement,is an endeavour to encourage and motivate public health professionals to do their bit towards driving public health reforms The most promising and impactful of these pilot projects will be showcased at the fourth edition of Healthcare Sabha. The Editor of Express Healthcare called upon each one of the public health experts to be the ambassadors of public health and initiate this social movement, by pledging their commitment towards driving this change.

EXPRESS HEALTHCARE

April 2018

HEALTHCARE SABHA 2018

Raising the bar in public health procurementâ&#x20AC;&#x201C; Powered byGLENMARK

lenmark hosted a power breakfast focussed on raising the bar in public health procurement moderated by Dr Suresh Saravdekar, Director, The Rural Health & Education Centre. Dr Prateek Rathi, Special Executive Officer, ESI Scheme, Department of Public Health, Maharashtra; Varsha Rathi, Professor, Radiology, Grant Medical College and JJ Group of Hospitals; AG Prasad, Divisional Head, Institutional Sales & Marketing at Glenmark Pharmaceuticals; Bejon Kumar Mishra, Founder / Director, Patient Safety and Access Initiative of India Foundation; Dr Tumge Loyi, Medical Officer, Directorate of Health Services, Government of Arunachal Pradesh; Dr M Lego, Director of Health Services, Department of Health, Government of Arunachal Pradesh; Dr OP Upadhyay, Medical Superintendent, Sir Sunderlal Hospital; R Rang Peter, Joint Secretary, Government of Manipur; Dr Pravin Shingare, Director, Directorate of Medical Education & Research, Government of Maharashtra; Dr BK Mohapatra, Additional Chief Medical Superintendent, Odisha State Medical Corporation; Dr JK Dev Varma, Director of Health Services, Government of Tripura; Dr Gajendra Kumar, Principal Executive Director/ Health, Indian Railways; Dr DK Sharma, Medical Superintendent, Department of Health, AIIMS Delhi; etc., were some of the delegates who attended the session. During the power discussion, national healthcare experts reinforced facts and shattered myths associated with procurement practices. Deliberations were made on challenges faced by procurement agencies to filter out manufacturers and ensuring direct deals which will help in maintaining a balance between quality and price. Suggestions were made to streamline the process and bring in transparency. The delegates discussed about various irregularities and lack of awareness that hinders the tendering and contracting processes in the procurement of medical supplies and about further mentioned the measures that need to be taken up. State representatives from Maharashtra and Kerala shared techniques and strategies that helped them streamline processes. These suggestions were welcomed by northeastern

EXPRESS HEALTHCARE

April 2018

states to improve their systems. The experts further listed down parameters that will comprise eligibility criteria for tender bidding. Unfortunately, there is only minimal time spent on regulating this first step which results in hampering the processes. In addition, there is a need to encourage the companies to compete in an environment which is quality driven. Recommendation to audit companies on their financial standing as a measure to avoid discrepancies in the long run were also discussed. They further recommended stringent actions against any breach of regulations. They also discussed on the urgent need to reform the procurement and distribution models existing in the public health sector. These measures will go a long way in reducing healthcare costs, opined experts presetn for the discussion. They further discussed several solutions that can be implemented at different levels to eliminate the existing gaps. They unanimously agreed that only through concerted efforts can the system be strengthened and made more effective.

PPPs success in healthcare Power-packed discussion on PPPs success in healthcare brought out some concrete submissions

he hour-long discussion, at Healthcare Sabha 2018, was presented by Philips Healthcare, which goes with the tagline ‘Innovating meaningful healthcare’. The discussion was on how PPP will help to develop a pan-India, integrated healthcare system. Initiating the panel discussion and giving the opening remarks, Jayakrushna Pani, Director, Government Business Philips HealthTech, said, “Our goal is to reach out to three million people ever year by 2025. Today, we have already touched upon 2.1 billion people in 2017 in India. Our focus segments in healthcare are preventive care, diagnostic and homecare.

Philips is one of the trusted healthcare brands, we are working closely with some states and trying to enhance the patient staff experience, simplifying the data handling, equipping them to get appropriate data. These steps are taken as Philips Healthcare is committed to improve the delivery of patient care by continually aligning technology investments and create a culture of security.” He further added that Philips is focussing on increasing PPP centres and they are currently working in Jharkhand and Haryana. Informing that PPP model will have a wide scale impact in the remotest of the places in India, Pani informed that

Philips has a long-term financial and technical strong partnership with the Manipal Group, which is a high volume-low margin business model. “We would like to get into more such partnerships. As we are a technology-based company, we can't hire doctors or paramedics but partnering with them can help us. The PPP should be people centric,”he added. Taking the discussion forward on how Philips is now focussing on PPPs, Pranav Chandna, Director Solutions (PPP, Design, Consulting, LSP) Philips -Indian Subcontinent, said, “Philips Healthcare wants to make a meaningful impact, as PPP is always about

making balance between the government and private players.” Participating in the discussion, the delegates from the government hospitals listed out few areas that should be looked upon for workable PPPs viz; a well-structured contract policy before implementation, monitoring the performance of the private sector and the need for a co-operative management between the public and private sectors. Summing up the session, Pani also added that the company is also encouraging local manufacturing under the Make-in-India initiative. Its Pune-based centre is becoming a manufacturing hub for Philips globally.

EXPRESS HEALTHCARE

April 2018

HEALTHCARE SABHA 2018

Express Public Health Awards honours heroes of public healthcare Lauds deserving projects in the public healthcare space which have paved the path for reforms in the current public health scenario

Winners and jury members at Express Public Health Awards

onouring public healthcare champions is a tradition at Healthcare Sabha. This year too, Express Public Health Awards were given to some very deserving projects across the country to acknowledge their efforts towards India’s public healthcare system. The awards nite began with a Welcome Address by Viveka Roychowdhury who welcomed the delegates and explained the vision and mission of Express Public Health Awards. She in-

EXPRESS HEALTHCARE

April 2018

troduced the esteemed jury and thanked them for their contribution in helping choose the most deserving winners. Roychowdhury gave a prelude to ‘Be The Change’ movement, an endeavour to encourage and motivate public health professionals to believe in themselves and do their bit towards driving public health reforms. Next, Dr Prabhakaran, VP (Research & Policy), PHFI and the Chairperson of the jury for Express Public

Health Awards took the stage to explain the methodology of the awards. Lauding Express Healthcare for this initiative, he explained the need to encourage good work in the sphere of public health. He went on to highlight various challenges in India’s public health and the need for effective strategies to mitigate them. His address was followed by the awards ceremony. Eight awards in six categories and one special recognition were given away to public health

champions across India. The winners of Express Public Health Awards were as follows: Category 1: Innovation in Increasing Affordable Access to Quality Medicines, Vaccines, Medical Products and Technology by a State Government Winner: Government of Haryana for their new innovative system called Online Drug Inventory and Supply Chain Management System (ODISCM) to monitor various government-spon-

sored health programmes. Category 2: Most Effective Health Technology Systems by a State Government Winner: Government of Odisha for providing three main aspects of primary healthcare in a brick and mortar dispensary within 45 minutes and offering consultancy with empanelled certified doctors through video conferencing.

which eligible households are given a CMHT health card to avail cashless treatment. It provides medical cover up to ` 2 lakhs per family per year for seven critical diseases and upto ` 50,000 for general ailments. Winner 2: Government of Kerala for their programme called Hridyam for Little Hearts that provides free access to healthcare for complicated paediatric cardiac surgery for newborn and children.

Category 3: The Most Efficiently Run Health Programme by a State Government Winner 1: Government of Manipur for their Chief Minister-gi Hakshelgi Tengbang (CMHT) project under

Category 4: Most effective PPP Winner 1: Ziqitza Healthcare for multiple initiatives aiming to offer counselling and promote awareness and a noteworthy PPP in healthcare infrastructure.

Winner 2: National Health Mission, Chhattisgarh for their efforts towards improving procurement services, supply chain and infrastructure development in two difficult districts of the state.

Jharkhand for providing quality care during pregnancy and childbirth for poor women, by training local women to provide healthcare in areas which have intermittent access to qualified medical professionals.

Category 5: Innovative Models of Financing Public Healthcare by a State Government Winner: Government of Chhattisgarh for making an alternate energy choice by opting for solar power plants and installed solar photovoltaic power plants across the state.

Special Recognition

Category 6: Most Effective Healthcare NGO Winner: Jan Chetna Manch, Bokaro,

Govt Tribal Speciality Hospital, Kottathara, Attappady, Palakkad, Kerala as a commendable attempt to provide quality treatment services as a first referral unit, completely free of cost in backward, tribal areas. The awards ceremony ended with a high note and a renewed commitment towards public health reform.

Government of Haryana

Government of Odisha

Government of Manipur

Government of Kerala

Ziqitza Healthcare

National Health Mission, Chhattisgarh

Jan Chetna Manch, Bokaro, Jharkhand

Government of Chhattisgarh

Govt TribalSpeciality Hospital, Kottathara, Attappady, Palakkad

EXPRESS HEALTHCARE

April 2018

BUSINESS AVENUES

EXPRESS HEALTHCARE

DO YOUR CLIENTS HAVE SEVERE COMPLAINTS OF...

EXPRESS HEALTHCARE

April 2018

BUSINESS AVENUES

EXPRESS HEALTHCARE

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

April 2018

EXPRESS HEALTHCARE

BUSINESS AVENUES

EXPRESS HEALTHCARE

PEEP

EXPRESS HEALTHCARE

April 2018

BUSINESS AVENUES

EXPRESS HEALTHCARE

Advertise in

Business Avenues Please Contact: ■ Mumbai: Douglas Menezes 91-9821580403 ■ Ahmedabad: Nirav Mistry 91-9586424033 ■ Delhi: Ambuj Kumar / Sunil Kumar 91-9999070900 / 91-9810718050 ■ Chennai/Bangalore: Kailash Purohit 91-9552537922 ■ Hyderabad: E.Mujahid 91-9849039936 ■ Kolkata: Ajanta 91-9831182580

April 2018

EXPRESS HEALTHCARE

BUSINESS AVENUES

EXPRESS HEALTHCARE

April 2018

BUSINESS AVENUES

April 2018

EXPRESS HEALTHCARE

BUSINESS AVENUES

EXPRESS HEALTHCARE

April 2018

BUSINESS AVENUES

April 2018

EXPRESS HEALTHCARE

BUSINESS AVENUES

EXPRESS HEALTHCARE

April 2018

BUSINESS AVENUES

April 2018

EXPRESS HEALTHCARE

BUSINESS AVENUES

EXPRESS HEALTHCARE

April 2018

BUSINESS AVENUES

EXPRESS HEALTHCARE

QVS-100 QUICK VITAL SIGN

SCREENS PATIENTS IN 2 MINS FOR 7 PARAMETERS 7 Parameters

Salient Features

Aesthetic

QVS/AI/44/2018/XPH

Design

April 2018

EXPRESS HEALTHCARE

TRADE AND TRENDS

Introducing Gen-next Analysers by DiaSys DiaSys India recently announced its foray in the field of haematology by launching very innovative haematology systems in respons family. Harshad Bhanushali, Product Manager, gives an insight

iaSys Diagnostics India, a subsidiary of DiaSys Diagnostic systems, ventured in the Indian diagnostic market in the year 2014 by introducing a gamut of new and innovative tests and analysers. Healthcare industry has the tradition of respecting innovations. Three kinds of innovation can make healthcare better and cheaper. One changes the way patients buy and use healthcare. Another uses technology to develop new products and treatments or otherwise improve care. The third generates new business models, particularly those that involve the horizontal or vertical integration of separate health care organisations or activities. In line with the above trend, DiaSys India recently announced foray in the field of haematology by launching very innovative haematology systems in respons family. These

systems are christened as respons 3H and respons 5H – innovative 3 part & 5 part differential haematology analysers. These technologically innovative systems perfectly compliment broad existing product portfolio of biochemistry, urine analysis, and point-of-care. With a footprint of A4 size paper and weight of approximately 9 kilograms, these are the new Gen-Next instruments in the field of haematology currently present in the Indian IVD market.

Cutting-edge technology ◗ respons haematology analysers are equipped with many exiting features. ◗ Shear rotary valve: respons haematology analysers are one of the very few analysers that use a shear rotary valve (SRV) for sample aspiration. ◗ For respons 5H, the sample volume aspirated is 25 µL and processed volume is just

2 x 1 µL. ◗ For respons 3H, the sample volume aspirated is 9.6 µL and the processed volume is just 2.4 µL ◗ Just one drop of blood is required!! ◗ Microfluidics: respons haematology analysers utilise microfluidics in a miniaturised module resulting in very low sample volume and thus very low reagent consumption. 70

per cent less reagent consumption than other analysers ◗ Economic operations: Low running costs Teflon tubing: Unlike majority of the analysers, respons haematology analysers utilises 100 per cent Teflon tubing resulting in very less wear and tear and thus low maintenance. Elegant design with user friendly software: Very simple and self-instructive software, which helps user navigate easily through the software. Just like a smart phone!! Remote access: Remote access tool gives the engineers an opportunity to connect with the analysers greatly reducing its down time. Respons haematology Systems are state-of-the-art instruments with an elegant design and smallest footprint. Respons 5H has measuring principle of laser based flow cytometry and volumetric impedance method along with mi-

crofluidics, reporting 26 parameters with two histograms and one Scattergram. Respons 3H has measuring principle of volumetric impedance method along with microfluidics, reporting 22 parameters with three histograms. Respons haematology analysers utilise only three reagents in the smallest of quantities With respons haematology analysers, we also contribute to the ‘go green initiative’ with use of low volume cyanide free reagents, thus generating very less waste, low power consumption and avoid paper printing. Contact details DiaSys Diagnostics India Plot No. A-821, TTC Indl. Area, Mahape, Navi Mumbai – 400710 Mob: +91 9029023012 Fax: +91 (022) 3371 4333 E-mail: harshad.bhanushali@diasys.in Website: www.diasys.in

Medical devices preferential market access policy highly disappointing: Indian Medical Device Manufacturers The Draft PMA policy in its present form does not provide preferential pricing to Indian manufacturers, no incentives on maintaining and improving quality, indigenous development RAJIV NATH, Forum Coordinator, (AIMED) Association of Indian Medical Device Industry has expressed deep disappointment over the Draft Medical Devices Preferential Market Access (PMA) Policy issued by DoP. “We are disappointed with the Draft of PMA policy issued by DoP. We will study it collectively and respond shortly but it is a clear case of a lost opportunity to promote indigenous manufacturing of medical devices to boost ‘Make in India’ ini-

tiative,” Nath said. The Draft PMA policy in its present form does not provide preferential pricing to Indian manufacturers, no incentives on maintaining and improving quality, indigenous development and no redressal / penal provisions against use of exclusionary 3rd country Regulatory approval mandatory clauses e.g. US FDA. It doesn’t provide for any corpus for ensuring no late payments by government. Such a corpus would be necessary to ward of any adverse impact on

financials of a company in case of delayed payments by the government. We are yet to study the Draft PMA in detail and take a stand but regret to note that following suggestions made by us to give encouragement and boost manufacturers producing in India over imports have not been considered. “The Prime Minister wants to boosts Make in India with Buy in India and DIPP provided a Preferential Purchase order with a 20 per cent margin of

preference for domestic manufacturers, however, this margin of preference is not preferential pricing of 20 per cent as is case in some countries like China which we are informed gives 1525 per cent price preference and others like Malaysia, Jordan, Uganda , Indonesia etc give 15 per cent but DIPP Order only allows Indian bidders to match the L1 Lowest price bid of a foreign manufacturer (Read Chinese) if his bid was within 20 per cent Range. The whole intention of Prime Minis-

ter and of amending GFR 153 got diluted , we wonder if he's aware of this ? “The option to match L1 Lowest price of a Chinese product is not a preference to an Indian Manufacturer - its only an option and this will hardly incentivise Indian manufacturing. Compare this to other countries like Indonesia, China, Malaysia, Jordan, Uganda etc. that give 15 per cent or higher price preference to manufacturers who produce in their country, opined Nath.

EXPRESS HEALTHCARE

April 2018

TRADE AND TRENDS

Carestream uses wireless digital X-ray technology at NFL Combine High-quality medical images help physicians assess players’ health and injuries IN ADDITION to demonstrating their speed, agility and strength at the 2018 National Football League Scouting Combine, top college football players also undergo comprehensive physical evaluations that include X-ray exams. This year a CARESTREAM DRX Core detector is being used with the existing X-ray system at Lucas Oil Stadium (Indianapolis, Ind.) to produce highquality diagnostic images in seconds. A Carestream DRX detector has delivered rapid image access at the NFL Combine for seven consecutive years with CARESTREAM DRX-Ascend and CARESTREAM Q-Rad Xray systems. The company’s DRX detector converts existing X-ray rooms and mobile units to the speed and convenience of full digital X-ray imaging in less than four hours. Additional imaging exams to evaluate athletes’ health were conducted at Indiana University Health Methodist Hospital in Indianapolis. NFL coaches, general managers and scouts who are preparing to draft new players evaluated more than 300 top prospects at the annual Combine. Multiple NFL teams—and other sports organisations worldwide—are using Carestream’s advanced digital medical imaging systems to diagnose and treat player injuries. The newest addition to Carestream’s growing portfolio is a cone beam CT (CBCT) imaging system that produces medical images for use in diagnosing conditions and injuries for professional athletes and recreational sports enthusiasts. The CARESTREAM OnSight 3D Extremity System enables sports medicine and orthopaedic specialists to capture 3D and weight-bearing images of hands, wrists, el-

EXPRESS HEALTHCARE

April 2018

bows, knees, feet and ankles, which provide important diagnostic information that is not available from traditional CT systems and other types of pa-

tient extremity exams. Carestream worked closely with leading orthopaedic specialists, sports medicine physicians and athletic train-

ers to develop this compact, affordable 3D imaging system for use in treating a variety of orthopaedic injuries and conditions.

Contact details Nilesh Dattatray Sanap Carestream Health India 022- 67248816 nilesh.sanap@carestream.com

TRADE AND TRENDS

Liver of brain dead patient transported in record time through green corridor The organ, which was transplanted later, was transported in three hours from Nasik to Jupiter Hospital, Baner THE LIVER of a brain dead patient was recently harvested and transported via green corridor from Nashik to Jupiter Hospital, Baner. The green corridor was created from Nashik to Pune. The liver left Nashik at 4.18 pm and reached Jupiter Hospital, Baner at around 7.25 pm, in about three hours (normally it takes six hours.) A patient was admitted with RTA head injury at Rishikesh Hospital Nashik on February 25, 2018. Since patient did not respond to the treatment, he was declared brain dead on February 25, at 6.30 am. Rishikesh Hospital, Nashik medical team counselled the relatives of brain dead patient for Organ donation, to

which they agreed voluntarily. Dr Gaurav Chaubal and Jupiter Hospitals liver team immediately travelled to Nashik and carried out the Organ retrieval procedure. The harvested liver was transported

from Nashik to Pune in less than three hours via the green corridor arranged by Pune and Nashik Traffic Police departments. The liver was transplanted in a 59-year-patient suffering from

liver cirrhosis at Jupiter Hospital, Baner. Talking about this, liver expert at Jupiter Hospitals, Dr Gaurav Chaubal said, “The family took a noble decision to donate organs which has helped in saving the lives of all the patients who have benefitted from this process. The doctors and patients family are grateful for this.” Dr Somnath Chattopadhyay, Liver Transplant Surgeon of Jupiter Hospitals said, “The decision by brain dead patient’s family to donate his liver to a needy patient is also worth appreciating. It is very important to note that, through organ donation one man can give a new lease of life to another man. Jupiter Hospital is trying its level best to increase awareness

about organ donation.” Dr Sunil Rao, COO, Jupiter Hospitals Baner said, “Society will get benefited if more people like this come forward for organ donation.” This surgery was conducted by Jupiter Hospitals Doctors team which consisted, Dr Somnath Chattopadhyay, Dr Gaurav Chaubal, Dr Sharan Narute, Dr Pavan Hanchanale and Dr Parijat Gupte. Ravindra Singhal CP Nashik, Rashmi Shukla, CP Pune, and Pune and Nashik traffic control team were thanked by the hospital administration for creating the green corridor. Also the role of Sagar Kakad, Coordinator Jupiter Hospital, Baner, was very instrumental in coordinating the entire green corridor.

India Design Council grants India Design Mark to Hindustan Syringes & Medical Devices The India Design Mark is a design standard, which symbolises excellence in form, function, quality, safety, sustainability and innovation and communicates that the product is usable, durable, aesthetically appealing and socially responsible HINDUSTAN SYRINGES and Medical Devices (HMD), world’s largest manufacturer of SMART (auto disable ) syringes has been granted the most significant distinction ‘India Design Mark’ by India Design Council, an autonomous body under Ministry of Commerce and Industry Government of India for its Safety Cathy IV Cannula used for Drug Delivery after having successfully completed the evaluation by the Jury. The award ceremony was recently held in Coimbatore. The India Design Mark is a design standard, which symbol-

ises excellence in form, function, quality, safety, sustainability and innovation and communicates that the product is usable, durable, aesthetically appealing and socially responsible. HMD has won the coveted India Design Mark for its recently introduced product ‘Cathy Safety IV Cannula.’ The Safety IV Cannula used for giving infusion of Drugs has a protective device 'SAFETY SIP CLIP' which encapsulates the tip of the used needle when introducer needle is extracted from the Catheter; Post Cannulation.“SAFETY SIP CLIP” prevents accidental needle stick in-

jury, provided that general effective and safe working procedures and precautions are maintained during its use and disposal. Expressing his gratitude, Rajiv Nath, Jt MD, HMD said, “We are delighted to be honoured by the most significant recognition for our safety IV Cannulas assuring excellence in aspect of design, quality and safety. Our product samples were evaluated by the Jury of India Design Mark, the Jury was satisfied with the uniqueness and benefits of the Design of our product and the India Design Mark is awarded to

HMD.” The objectives of India Design Mark is: ◗ To use the design as strategic element for business excellence ◗ To Promote Design as a tool for innovation and economic competitiveness in industry ◗ To promote the concept of environment friendly designs ◗ The award was announced by Pradyumna Vyas, Member Secretary, India Design Council and eminent personalities associated with public and private healthcare, government establishments and healthcare consultancies. “While this is a prestigious

recognition for us at HMD to make the quest for the India Design Mark more popular the procurement officer in Private & Public Healthcare need to give a preference to Medical Devices with the Design to encourage Manufacturer to invest in Quality & Design,” said Nath. Nath also stressed that government urgently needs to deploy ‘Safety I V Cannulas’ to Limit HIV & Hepatitis Epidemics in the country and to protect healthcare workers from accidental needle stick injuries while treating infected patients.

EXPRESS HEALTHCARE

April 2018

TRADE AND TRENDS I N T E R V I E W

Women are possibly accessing kidney health lesser and later, missing an opportunity to detect kidney disease in an early phase Dr Suresh Sankar, MD, Chief Medical Officer, DaVita Care (India) in a candid interaction with Express Healthcare, talks about women’s health and kidney disease, sharing some insights from his 19 years of clinical experience What is the prevalence of kidney disease among women in India? We are unsure whether kidney disease is more common or less common among women as compared to men. It is possible that kidney disease is marginally lesser in women because major risk factors for kidney disease such as high blood pressure, diabetes, and smoking behaviour are reported to be lesser in women; however, there are other diseases such as lupus nephritis (a kidney disease caused by an autoimmune disease) which are more common in women. Do women have equitable access to kidney healthcare in India? Based on what we have observed, women are likely to have less access to kidney care and therefore miss opportunities to detect the disease at an early stage and implement effective therapy. As per the Indian CKD Registry, only 30 percent of CKD patients consulting a nephrologist were women. A similar pattern is evident among haemodialysis patients in India. In developed countries, where data on incidence of kidney disease is available, it has been observed that there is gender variation in incidence of kidney disease. Hence the lower percentage of women under treatment for kidney disease in such countries is likely to be due to gender

EXPRESS HEALTHCARE

April 2018

variance in health-seeking behaviour. However, this observed gender variance does not explain the larger gender variance observed in kidney care in India. Given the present scenario in India, there is a lot of room for improvement as far as women’s access to kidney healthcare is concerned. Can you share some insights on the challenges and opportunities to improve dialysis access in India, especially for women? The Pradhan Mantri National Dialysis Programme, which has the provision of free dialysis services to the poor, and the National Health Insurance Scheme, which aims to cover around 10 crore vulnerable families, are two big initiatives by the Indian government to improve access to dialysis care in India. One of the key challenges is to meet minimum quality standards of dialysis, while simultaneously providing access across the country. We must understand that haemodialysis is resource intensive – from a biomedical, energy, natural resource (including large amounts of high-quality water) and human perspective. We may need to look at global models for telemonitoring of dialysis like those in Colombia or explore Peritoneal Dialysis for certain sections of population, similar to Thailand. How can the government and the healthcare industry contribute positively to

In developed countries, where data on incidence of kidney disease is available, it has been observed that there is gender variation in incidence of kidney disease improving women’s health? Several government programmes are womencentric but have been predominantly focussed on

maternal health; and quite rightly so. These programmes have contributed enormously towards not only improving women’s health but also improving the health of new borns, infants and children. Outcome indictors like lesser maternal mortality rate and lesser anaemia in adolescent girls are significant achievements resulting from such public health programs The private sector has also contributed immensely in this space but there are few objective ways to understand the impact of same. The newer areas evolving may be wellness, elderly women care, non-communicable diseases in women – there is a lot of scope here. How does DaVita ensure superior clinical outcomes for its dialysis patients? DaVita is a leader in clinical excellence in chronic haemodialysis care in the US. It has adopted similar practices in 11 countries, including India. Firstly, we have a clinical quality team overseeing patient care in all clinics in India. Secondly, we have well-defined policies and procedures, for which appropriate training is conducted. Thirdly, periodic audits track short falls and trigger corrective actions. Lastly and most importantly, we have set feasible targets for important clinical metrics in dialysis and monthly audits for interventions focussed on patients who are unable to achieve clinical targets. All of

the above help ensure that the best possible clinical outcome is achieved. The lacunae in India are benchmarks and dialysis registry. Either of the above will pave the way for lifting the standard of care for all dialysis patients in India. What, according to you, are the global practices in DaVita which set you apart from other dialysis providers in India? Several of the initiatives discussed above address this question. But foremost is a commitment to quality and make ‘best quality clinical outcome’ as an organizational focus. In that way, all functions, and not just the clinical team, are focused on the overarching objective of our patient care. IT ensures that the EMR / information systems are in place, operations functions closely with clinical team to ensure biomedical and team support are at their best and marketing has the right messaging. While in Indian health care the dialogue usually revolves around structural aspects, tangibles and off late processes around care delivery, we would like to elevate the quality paradigm to clinical outcomes of our patients. Contact details DaVita Care (India) #1/1, First Floor, Berlie Street, Langford Town, Bengaluru 560025, India | Mob: +91 819759438

TRADE AND TRENDS

The flexibility and ambiguity of the Crispr-Cas9 patent landscape Dr Malathi Lakshmikumaran and Dr Deepti Malhotra, experts from Lakshmikumaran & Sridharan, give an insight on how CRISPR-Cas9 system occurs naturally as an adaptive immune response in bacteria (prokaryotes) which use this system to detect and kill any viruses that infect them THE ABILITY to manipulate an organism’s genome at will, and make precise changes without leaving a trace is among the holy grails of life sciences. This would allow scientists to find the cure for many genetic diseases, develop better crop varieties, among other varied uses and possibilities to develop breakthrough scientific discoveries. While several genetic engineering technologies have been developed, none demonstrate the accuracy and precision of a newcomer in this field called CRISPR-Cas9.

CRISPR-Cas9 system CRISPR stands for Clustered Regularly Interspaced Short Palindromic Repeats, while Cas9 stands for CRISPR-associated protein-9 nuclease and it is an enzyme. The CRISPRCas9 system is a complex of Cas9 protein with small ribonucleic acid (RNA), called crRNA. The crRNA acts as a guide for the enzyme to locate specific complementary target DNA sequences in an organism’s genome, while the enzyme, Cas9 possesses the ability to remove the target DNA sequence entirely, and/or introduce a desired sequence in its place. This system occurs naturally as an adaptive immune response in bacteria (prokaryotes) which use this system to detect and kill any viruses that infect them. Although the mechanism was discovered and elaborated in prokaryotes, scientists have now adapted this system for use in plants and animals (eukaryotes).

The patent battle: From origins to current status The discovery and develop-

Dr Malathi Lakshmikumaran, Lakshmikumaran & Sridharan

ment of the CRISPR-Cas9 system can be credited to several different researchers over the last two decades, however, the two main groups who at present are involved in extensive patent litigations to claim the right over this invention are Jennifer Doudna and Emmanuelle Charpentier, represented by the University of Berkeley, California; and George Church and Feng Zhang, represented by the Broad Institute, Massachusetts. The Berkeley group were the first to file for a patent which is yet to be granted, while the Broad Institute filed an application for a patent in December 2012. As the Broad group opted for a fast-track review process, the patent was granted in April

2014 (US8697359 B1). The formal process for grant in the US is as per the first-to-file system which was instated post March 2013; however, as the Berkeley group’s application was filed in 2012 this system was not yet applicable. Therefore, they opted for patent interference proceedings against the Broad Group, which in simple terms means that the two patents were directed towards substantially the same invention. The proceedings begun in January 2016, and a year later in February 2017, the Patent Trial and Appeal Board (PTAB) passed a judgement in favour of the Broad Group. The basis of the PTAB’s decision was on the Broad Group’s motion for no inter-

ference-in-fact. This in layman’s terms means that the two contested patents are separate entities that neither cancel nor refuse either party’s claims. The determination of interference is essentially based on the comparison of the claims of the stated invention (the two-way test), to determine if “the subject matter of a claim, would, if prior art, have anticipated or rendered obvious the subject matter of a claim of the opposing party and vice versa” 37 C.F.R 41.203(a). The verdict was based considering the Berkeley group’s application constituting prior art. The assessment for lack of anticipation was based on the fact that the Berkeley group’s claims were not system i.e. organism specific, while the Broad group’s claims were specifically directed towards eukaryotic systems. Therefore, the judgement was in favour of no interference with regard to the anticipation of Broad group claims vs Berkeley group claims. The assessment of obviousness was based on the criterion of “whether the prior art would have suggested to one of ordinary skill in the art that this process should be carried out and would have reasonable likelihood of success, viewed in the light of the prior art.” In re Dow Chemical Co., 837 F.2d 469, 473 (Fed. Cir. 1988). The point of significance in this judgment is the understanding of what is considered “reasonable likelihood of success”. In the PTAB’s view, this refers to an assumption that certainty of success is not a requirement. Medichem, S.A. v. 24 Rolabo,

S.L., 437 F.3d 1157, 1165–66 (Fed. Cir. 2006), citing In re O'Farrell, 853 F.2d 894, 903–04 (Fed.Cir.1988). The decision was made with the analysis of several witness comments in the interference proceedings. While the board acknowledged Dr Doudna had expressed the intention to extend the system to eukaryotes, the expectation that system would work in higher systems was debatable. The board quoted that Dr Doudna had herself made several attempts to get the system to work in human cells, however, could not achieve success. While the Berkeley group cited evidence that several groups managed to adapt the system to eukaryotic systems only following their initial scientific publication of 2012, the PTAB was not persuaded by this argument as they maintained that this would not convince a person of ordinary skill in the art, that CRISPRCas9 is a system that could work well in eukaryotes as well. While the judgement of the PTAB has been appealed by the Berkeley group, as it stands, the verdict causes ambiguity to the licensing process. While the Berkeley group’s claims are broad and cover the application of CRISPR technology across different platforms, the question as to whether licenses will be required from both or one of the contending groups is a source of confusion among companies. To add to the uncertainty regarding this technology, the EPO has recently favoured the grant of the Berkeley Patent. Furthermore, the Broad group’s patent has been recently

EXPRESS HEALTHCARE

April 2018

TRADE AND TRENDS revoked due to procedural issues with regards the inventors listed on the said patent filed at the EPO. The Berkeley group has recently filed an appeal with the US Court of Appeals for the Federal Circuit in Washington, DC; to appeal the PTAB’s impugned decision on the lack of interference in favour of the Broad group that had given them the rights to a separate patent. The Broad group provided their arguments at the Appellate court on October 25, 2017, and the court ruled in favour of the Broad group. Hence, the opposing decisions at the USPTO and the EPO and the various licenses that may be required by the third-party practitioners leave everything up in the air with regards the future of the CRISPR technology. Further, with the advent of the competing gene-editing technology within the CRISPR-Cas9 realm, like Cpf1 nuclease, C2c1, C2c2 and C2c3 nucleases to name a few, the competition is diversifying and the patent as well as licensing landscape only becoming more involved albeit confusing. None of the same patent battles mar the new CRISPRnuclease systems, thus leading to more clarity in the associated patent landscape for the alternative CRISPR-nuclease systems. Further, populating the confusion and yet providing options in the realm of geneediting with similar systems is the recent compilation of

EXPRESS HEALTHCARE

April 2018

CRISPR-Cas9 future will pave the path to new advances in medical and agricultural sciences; the question of who owns the invention needs a 'crisp' resolution studies published in Science issue dated January 25, 2018, where it is reported that 10 more immune systems have recently been discovered in bacteria that use inherent tools to protect themselves against phages and plasmids, opening up the possibility of addition of new tools to the molecular biology toolbox and opening the gene-editing patent landscape further. A fight which is likely to be fought to the end, CRISPRCas9 future will pave the path to new advances in medical and agricultural sciences; the question of who owns the invention needs a 'crisp' resolution.

Licensing the disputed technology Exclusivity in the marketplace is a good place to stand, and the same holds true for exclusive licensing of the patented products, especially if the license-holder wishes to enter clinical trials. But, this may be difficult feat to achieve for a disputed and distributed technology such as Crispr gene-editing system, wherein a number of patent holders hold key patents and the pio-

neers have a confusing stand under the various jurisdictions. With that in mind, last year, Denver, Colorado–based MPEG LA, LLC formed a patent pool for CRISPR-Cas9 technologies, inviting relevant parties to submit their patented tools to a single consortium that would simplify the licensing process—one license would grant licensees access to the pool’s slew of patents. This should ease the pressure on the licensee and allow the access through nonexclusive licensing agreements to various players be it small or big and yet, allow profit to be gained by the patent owners through royalty payments. Since, the patent landscape for the Crispr-Cas9 system is ever-so crowded, licensing every relevant patent can be costly and time-consuming, restricting the number of licenses a small company can obtain. Thus, for a complex situation as that of the Crispr-Cas9 system and similar debated and shared technologies to emerge in the coming future. A pool, however, would allow the patent holders to achieve a broader scope of licensing of their IP

rights, while promoting equivalent access to a greater and variant number of players. However, this leaves the issue of exclusivity, wherein a market monopoly incentivises companies to take on the costs and liability of developing CRISPR-based treatment for disease. There is a reason for the non-existence of similar patent pools for other therapies and medical advances. One approach may be to opt for target-specific, disease-specific exclusive licenses in therapy that would allow exclusive marketing albeit with the non-exclusive license of the foundational patents.

Would Crispr be one solution to all gene editing problems in disease? While, CRISPR provides the probability to revolutionise therapy for genetic and environmental diseases via gene therapy, the genetic diversity in the nucleotide sequence level may stand in the way of one size fits all and prevent mass production of treatments. Variations in DNA sequences are common among humans as well as in patients,

especially in diseases like cancer. Whereas, the therapy may be personalised to enhance efficacy and reduce offtarget effects, it would still entail detailed genomic studies. Thus, the on-going and approved clinical trials are highly anticipated to determine the therapeutic potential of the Crispr system.

The issue of regulation or lack thereof? Interestingly, in the realm of plants and agro-biotechnology, recent decisions from the United States Department of Agriculture (USDA) have stated that the CRISPR-Cas9edited plants can be cultivated and sold in the markets free from regulation. The change in the USDA’s attitude towards genetically modified plants, which maintains a very stringent and unrelenting attitude towards genetically modified organisms (GMO) produced by Agrobacterium-mediated transformation and generation of transgenic plants that in USDA’s opinion comprise of foreign DNA from “plant pests,” the CRISPR-Cas9-edited plants have been deemed to lie outside such a scope because the technology manipulates or knocks out the plant’s own genetic material i.e. works on endogenous genes. Thus, CRISPR-Cas9-edited plants are slated to be given a free pass on entry into the market. However, the IP licensing on the same remains shrouded in doubt.

IUIH will provide world-class healthcare in 2 more states Each IUIH Medicity, including the ones to come up in Assam and UP, shall have a 1000-bed hospital in association with one of UK’s leading NHS hospital

Indo UK Institute of Health (IUIH), one of the largest public-private partnership (PPP) healthcare infrastructure projects in the world has recently signed up MoUs with Government of Assam and Government of Uttar Pradesh for setting up integrated IUIH Medicities. Signed during the recently concluded Advantage Assam, Assam Global Investors’ Summit 2018 held at Guwahati; and UP Investors Summit 2018 held at Lucknow; these initiatives shall deliver to the people of the Assam and Uttar Pradesh world-class NHS standard healthcare that’s available, affordable and accountable. Besides Uttar Pradesh, the other states to benefit from the IUIH programme include Maharashtra, Andhra Pradesh, Telangana, Punjab, Gujarat, Rajasthan, Karnataka, Madhya Pradesh, Haryana and Assam. The Indo UK Institute of Health (IUIH) Medicity Programme was announced as a Joint Statement between the Prime Minister of India Shri Narendra Modi and the former Prime Minister of the United Kingdom David Cameron in 2015. The programme is aimed at benefitting over 400 million Indians. Healthcare UK and Department for International Trade (DIT) India are supporting IUIH with its plans. The project is supported by Ministry of Health and Family Welfare, Government of India and Invest India, which is the national investment promotion and facilitation agency for India promoted by Department of Industrial Policy and Promotion, Ministry of Commerce and Industry, Government of India.

UP Investor's Summit

Advantage Assam

EXPRESS HEALTHCARE

April 2018

DR AJAY RAJAN GUPTA

HOWARD LYONS

DR RAJDEEP SINGH CHHINA

Director, IUIH

PARDEEP SOOD

MD and Group CEO, IUIH

Board Member, IUIH

COO, IUIH

VP – infrastructure, IUIH

Each IUIH Medicity, including the ones to come up in Assam and UP, shall have a 1000 bed hospital in association with one of UK’s leading NHS hospital. Besides the 1000-bed hospital, the IUIH Medicities in Assam and Uttar Pradesh shall also have medical college, nursing college, PG academy and a training facility for allied health professionals. IUIH has tied up with some of the leading implant companies, and medical equipment and device manufacturers. Many of them would start their manufacturing operations in IUIH Medicities.

Plans are also afoot for employee exchange programmes, where medical staff from India will be working in NHS at UK and vice versa. It’s a great opportunity for NHS staff as well to enrich their experience and knowledge by working in India.

Our intent is to enable Assam and Uttar Pradesh to emerge as hubs for medical tourism, medical equipment and device manufacturing, pharmaceutical production and cutting-edge medical research in areas as diverse as genomics & stem cells, translational research and clinical research leveraging on the patient data available. IUIH Medicities in both the states shall attract patient traffic as they will offer NHS standard healthcare at lower price points.

We are also relying heavily on technology for big data analytics. Our e-Health and mHealth platforms will facilitate exchange of patients’ medical records electronically using telemedicine, tele-radiology and tele-pathology for diagnostics etc.

The construction work of IUIH Medicity has begun in Nagpur and Larsen & Toubro, one of the tallest names in the business is executing this project for us. In August 2017, the foundation stone of IUIH Medicity Nagpur and IUIH Medicity Amaravati were unveiled by Hon’ble Chief Minister of Maharashtra Shri Devendra Fadnavis and Hon’ble Chief Minister of Andhra Pradesh Shri Nara Chandra Babu Naidu respectively.

EXPRESS HEALTHCARE

April 2018

VINAY SINGHAL

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