Healthcare in India

India plans to suspend sale of medicines that are banned in one of the six major global drug markets for harmful side-effects, said two senior government officials.

According to a health ministry official, if a drug is banned by the US, UK, Canada, Japan, European Union or Australia, its sales will be stopped in India until clinical data proves that it will not have adverse effect on patients in the country. These embargoes will be triggered by future action of international regulators, and will not automatically apply to drugs that have already been banned in the developed countries.

Drug Controller General of India GN Singh confirmed such a move was on the anvil. "We are in the process of streamlining a mechanism through which our drug regulatory system takes an initial cue from the decisions of leading drug regulators globally on banned drugs. These drug regulators already have in place robust systems to generate and analyse volumes of data on adverse drug reactions to reach decision on drug bans," said Singh.

The proposal to link medicine bans in the country to the verdicts of regulators in developed countries is significant as India at present does not have a sound system in place to filter and shunt drugs that trigger serious side-effects.

What if hospitals were run like a mix of Wal-Mart and a low-cost airline? The result might be something like the chain of "no-frills" Narayana Hrudayalaya clinics in southern India.

Using pre-fabricated buildings, stripping out air-conditioning and even training visitors to help with post-operative care, the group believes it can cut the cost of heart surgery to an astonishing 800 dollars.

"Today healthcare has got phenomenal services to offer. Almost every disease can be cured and if you can't cure patients, you can give them meaningful life," says company founder Devi Shetty, one of the world's most famous heart surgeons.

"But what percentage of the people of this planet can afford it? A hundred years after the first heart surgery, less than 10 percent of the world's population can," he told AFP from his office in hi-tech hub Bangalore.

Already famous for his "heart factory" in Bangalore, which does the highest number of cardiac operations in the world, the latest Narayana Hrudayalaya ("Temple of the Heart") projects are ultra low-cost facilities.

The first is a single-storey hospital in Mysore, two hours drive from Bangalore, which was built for about 400 million rupees (7.4 million dollars) in only 10 months and recently opened its doors.

Set amid palm trees and with five operating theatres for cardiac, brain and kidney procedures, Shetty boasts how it was built at a fraction of the cost of equivalents in the rich world.

"Near Stanford (in the US), they are building a 200-300 bed hospital. They are likely to spend over 600 million dollars," he said.

"There is a hospital coming up in London. They are likely to spend over a billion pounds," added the father of four, who has a large print of mother Teresa on his wall -- one of his most famous patients.

"Our target is to build and equip a hospital for six million dollars and build it in six months."

The Mysore facility represents his vision for the future of healthcare in India -- and a model likely to burnish India's reputation as a centre for low-cost innovation in the developing world.

Air-conditioning is restricted to operating theatres and intensive care units. Ventilation comes from large windows on the wards.

The state government on Thursday introduced a telemedicine programme in Ganjam district, which aims at connecting all peripheral health centres with reputed medical colleges in the country for improved patient care in rural areas. The programme is already available in nine district headquarters hospitals and three medical college and hospitals.

Launching the public private partnership (PPP) initiative at City Hospital here, health minister Damodar Rout said patients from rural areas can get timely and quality services through the network without going to major hospitals in far off places. By June, all the 30 districts will be covered by the programme, he added.

Bhubaneswar-based Odisha Trust of Technical Education and Training (OTTET), the private partner in the move, would invest Rs 6,000 crore in the project. "Around one lakh people will get direct employment and five lakh people indirect employment in the project," said OTTET managing trustee K N Bhagat.

A trained person to handle telemedicine equipment would be appointed in each village. He can consult with the doctors required through the network, he said. The persons to be appointed would get one-month training from Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow, he added. A standard operating protocol (SOP) is developed with discussions between the government and implementing agency.

"OTTET will develop a dedicated website where information on the technology, its use for project, feedbacks, and contact details will be available. The information will be updated periodically. It will ensure timely consultation from specialists," said a senior doctor.

The City Hospital has provided a room to installation of instruments for the purpose.

"We have also decided to provide a space in out-patients department for operating the centre," said principal of MKCG Medical College and Hospital A K Dandapat.

IBM has shared short and long term recommendations with Pune Municipal Corporation for providing its citizens with improved health and transportation services. 

For Pune's healthcare, IBM felt that the use of low cost mobile phones to gather and report information could help officials more quickly identify and resolve both short term events, such as disease outbreaks, and chronic public health issues, such as infant mortality.  

For example, with the proper consents, citizens could use their mobile phones as a way to automatically update physicians about their health status.  Their phones might also receive SMS alerts when a child is due to receive immunisation or when precautions need to be taken during public health emergencies.  

A single, region-wide telephone number to summon emergency responders would make it easier for citizens to receive assistance for health and safety issues, such as for severe illness, accidents and assaults.

Fujitsu Laboratories Ltd. has developed software that measures a person’s pulse from an image of their face as seen by a webcam-style camera, the company said.

It said a portable device such as a smartphone could, therefore, become a sophisticated pulse-rate monitor with a wide range of potential uses, including as a gadget to monitor one’s health condition. It might have potential security applications, too, as a monitor to check the pulse rate of a person acting suspiciously in a public place.

The software works by detecting variations in the brightness of a person’s face, which pulses subtly according to blood flow.

And it is easy to use: The device needs only to be pointed at somebody’s face; within five seconds it is possible to calculate a pulse rate; and if the person stays in place, it can detect changes in real time.

It has a margin of error of three beats per minute, compared to the often 100 percent accuracy achieved when measuring a person’s pulse directly by touching their skin.

The device can be used if it is sufficiently bright to capture the color changes in a person’s face. But tests showed it could work even in situations where a woman subject is wearing makeup, Fujitsu said.

The company said there could be important applications in security, where a suspect’s abnormally high pulse rate can indicate ill-intent. It could also be used to monitor the stress levels of company employees.

Exceprt from an Interview in eHealth with  Dr. Harish Jachak, Manager Presales and Marketing, Birlamedisoft Pvt. Ltd.

How do you visualise the Indian blood bank scenario ?

We know that healthcare industry in India is highly unregulated. But this may not come true in case of Blood Banks. They, on the other hand, are under regulation and monitoring of Central and state governments and agencies like NACO and AIDS control societies. Also now a days opening a blood bank has become very difficult. If you ask me about growth of blood banks, I would straight away say, its slow, very slow. How many blood banks you have heard of that started in last one year? On top of that blood banking facilities are limited to major cities only. We need more storage units in small towns, ” well connected” storage units.

Its these regulations and statutory requirements which make the role of ICT in blood bank very important. Blood bank employees need to maintain atleast 10 to 15 different types of registers and records for reporting purpose. Since there are many regulators and each have different formats for their records, this process of record keeping is very time consuming and cumbersome.

How do you feel ICT is working to overcome the problem ?

Proper implementation of Information and Communication Technology (ICT) can change for good how blood banks function.
• Bar coding and scanning technology can reduce miss-reporting.
• Timely reminders of expiring bags, with identification of bags can make staff to distribute older bags first (FIFO model). This will not only reduce cost of storage but also money lost with discarded bags.
• Real time status of available stock in storage centres and/or blood bank will help in maintaining optimal level of usable bags.
• Online data of donors would be helpful in identifying habitual donors, maintaining contact list in case of emergency, etc.
• Forecasting of blood demand or possible stock-outs in near future will help blood banks to plan and replenish stock well in advance by arranging blood donation camps.
• Interfacing with machines can be done so there remains no need of manual entry of test results. Bar code and stickers printing further reduces any chances of human error.
• Web based blood banks information management systems will allow the users to enter the data of donors and bags at the point of collection. Otherwise staff have to enter data once they come to centre form any camp. This results in duplication of efforts.
• Well formatted reports can suffice requirement of any regulating agency. No need of repeating the entries in each report.
• Full array of MIS reports for administrators of blood bank facilities.
• Customer support features like SMS, online booking of blood for planned surgeries, etc. will definitely lead to customers satisfaction.

The Planning Commission has recommended “more powers” to the Ministry of Health and Family Welfare to strengthen the drug regulatory system.

“Price controls and price regulation, especially of essentialThe Planning Commission has recommended “more powers” to the Ministry of Health and Family Welfare to strengthen the drug regulatory system. drugs, should be enforced. The Essential Drugs List needs to be revised and expanded, and rational use of drugs ensured. Public sector should be strengthened to protect the capacity of domestic drug and vaccines industry to meet national needs. Safeguards provided by Indian patents law and the TRIPS Agreement against the country’s ability to produce essential drugs should be protected. MoHFW should be empowered to strengthen the drug regulatory system,” the document said.

The panel also suggested a National Health Package to offer, as part of the entitlement of every citizen, essential health services at different levels of the healthcare delivery system.

Mobile telephony is not a panacea for all health challenges in the developing world. But there is enough experience – and the beginnings of an evidence base – to argue that mHealth deserves serious attention from any development actor seeking to improve global health.

A policy briefing focusing on how the mobile phone offers important opportunities for saving lives, drawing on BBC Media Action's direct experience in using phones to improve health education in one of the poorest states of India.

This briefing focuses on how one of the greatest engines of innovation in the 21st century – the mobile phone – provides a high-impact solution to save lives. It identifies three aspects of mHealth – the delivery of healthcare information and services via mobile communication devices – that renders it such a potentially robust healthcare tool:

• Reach. The first is its capacity to leverage existing – and quite basic – phones to provide life-saving information to people in difficult-to-reach, rural areas.

• Design. The second is its capacity to tailor both the delivery and content of that information to the needs of poor, illiterate and marginalised populations.

• Scale. The third is its capacity to operate at scale in a cost-effective, financially sustainable way.

Here on center stage in the global crisis of drug-resistant tuberculosis, top doctors are sounding a new alarm: India's emergency strategy to defeat the disease may be having the opposite effect—encouraging TB instead to mutate into more deadly and unstoppable strains.

In its new strategy, India is treating some, and perhaps many, drug-resistant TB patients with drugs that they are already resistant to. That can allow the bacteria to build resistance to new drugs as well.

On Friday, a prominent specialist described research to The Wall Street Journal showing that the government's treatment plan wouldn't work on fully two-thirds of the 300 patients analyzed at one major Mumbai hospital. The results suggest India's plan is "a futile exercise" that will "serve to amplify resistance," said the researcher, Dr. Zarir Udwadia. "It is morally and medically disastrous."

A Mulund-hospital has recently introduced a new technique to deal with complicated cases of coronary heart disease.

The procedure termed as bifurcation stenting was used on a 59-year-old female with a history of myocardial infarction and left ventricular failure. Interventional cardiologist Dr Suresh Vijan, who performed the surgery on the patient, claimed it to be the country's first. It was performed at theFortis Hospital in Mulund.

Vijan said, "The patient had hypertension anddiabetes for many years. Sometime back she had suffered a minor heart attack and left ventricular failure and was admitted in Ambarnath. Later, an angiography revealed that she had severe (90%) stenosis in right coronary artery. The clots were at complicated sites," he said. Medical journals explain bifurcation lesions as clotting that may involve the main vessel, the distal and side branch.

Explaining bifurcation Stenting, Vijan said bifurcation lesions are considered the most complex. He said that such procedure also take longer to perform.

"Currently, procedures to treat bifurcation lesions are associated with higher rate of periprocedural heart attacks, and are also associated with higher rates of retenosis and stent thrombosis," he said. He said that a number of dedicated stents have been also developed to deal with this problem with limitation of procedural complexities.

mHealth is one area which has major scope in developing countries like India, especially in the field of health Information delivery. It can play a major role in improving the health literacy among rural population. But there are barriers to the growth of mHealth in India. India is a country with numerous languages, diverse culture and living styles which makes it difficult to propagate standard set of information to people from all walks of life. Innovative ideas should be formulated to target people with differing languages and literacy levels, thus widening the scope for mHealth development in India.

Literacy
Over the years, the literacy levels at rural areas have improved considerably. But there is a vast rural population who keep education as the last priority on their list. Another aspect which needs to be stressed upon, is the ‘health literacy’ of the population which helps them independent decisions on their own or their families health issues when the need arises. To improve the health literacy among such people is always a challenge. Unless these people are covered, none of the campaigns will be complete. Oral presentation and visual aids will be the best method to educate them. But the effectiveness of hearing or seeing something just ones or twice need to be studied. Here mHealth also have limitations as the target population may not read the text messages if send to them. This area requires Intervention to study and formulate effective use of mHealth technology such as developing, audio or video messages which will have a scope in the long run.

Language
Individual mother tongues in India number several hundred. The 1991 census recognized “1576 rationalized mother tongues” which were further grouped into language categories. Considering a country like India with hundreds of languages and low literacy levels in the rural population, mass education strategies may not workout. Regional, TV and Radio coverage will have a positive result in such cases. But the limitation is that it can support general campaigning ads, talk shows or documentaries which may or may not propagate the message to all the people. mHealth technology has a virtuous scope in this area by reaching the target population with information in their own regional language specially to each individual.

Culture & Geographic location

Sometimes cultural barriers can undo any multimillion dollar deal says Geoff Williams in his article in Entrepreneur. ‘India is an ancient culture that’s been around for 5,000 years.(7) The geographic variations in India are assorted. The Indian population is distributed along a variety of cultural variations. The diversity is so vivid that addressing the whole population with a standard information set will be difficult. For instance, if information on diet modification for expecting mothers has to be formulated, it cannot be same throughout the country, as the availability of raw materials differ in different regions. Believes and culture also varies across the country thus making it difficult to convince the people about new things. These brain barriers are difficult to break as they were believes followed by them for quiet long. In spite of all the campaigning efforts undertaken by the Government, still there are people who have mind blocks towards vaccinations for children. It requires a patient and undying effort to resolve such mind blocks towards health initiatives.

Technological illiteracy
Access and use of new information and communications technologies is one way to improve the social and economic development of a community. From a layman’s point of view, Technology is a broad term which includes many complicated process involving machines. ‘The term digital divide has become an increasingly frequent way to describe gaps between rich and poor countries and between rich and poor populations with in the countries’.(8)

A recent visit to Philips Innovation Center (PIC) in Bangalore, India enabled me to witness some path breaking medical technologies and devices, developed by Philips Healthcare,  that are set to transform the current status of healthcare market. Philips, with its ‘Open Innovation Strategy’, has combined the innovative prowess of partnering companies and researchers to bring innovative products and services to the market.

PIC Healthcare, with its major focus on constantly improving patient care, has been a preferred choice and one of the leading suppliers of diagnostic systems. They plan to revolutionize the healthcare diagnostic and medical device market through the following introductions:

Heart Navigator: As the name suggests this helps cardiac surgeons to view live images of catheters and heart valve positions in real which will aid in effective and efficient device positioning such as required for heart valve replacement procedures.  It enables an automated planning to help simplify complex structural heart disease procedures by creating an excellent 3D image.

Tumor Tracking Application: This application is made to assist clinicians in detection, diagnosis, staging and monitoring of cancer by measuring patient’s tumor progression over an elongated period of time and thus provide more robust treatment planning. It provides comparison and in-depth analysis by measuring changes in tumor volume and metabolic activity which simplifies the treatment regime.

eICU Programs: It creates a single ICU hub, monitored by critical specialists, which will connect several remote hospitals’ ICU through bed side connected monitors and real-time video images of patient conditions. This will be a blessing in hospitals in a country like India where there is a shortage of skilled clinicians and other healthcare professional. Moreover, imagine the role eICU program would play in remote areas of India where majority of the population do not have access to best doctors and healthcare facility by creating a virtual ICU. Philips has installed this in few Indian hospitals and plan to expand its services in several others.

iDose4: This advanced iterative reconstruction technique allows radiologists to personalize image quality based on each patient’s needs with an enhanced image quality. More importantly, it reduces the radiation exposure of the patient to considerable extent thereby reducing the complications involved with radio-diagnostic procedures.  Watch this video to understand the advantages of iDose4.

Delivering health care to a billion-plus population is very complex. And, like eating a Reese’s, there’s no right way to do it. In the past, Indian entrepreneurs have innovated on several business models that range from frugal to world-class luxury care.

A testimony to its success is the fact that citizens spent Rs 1,650 billion, or 3.16 percent of the GDP (in 2011-12), on health care, whereas the government spent only 1.04 percent. In other words, a family of four spends nearly Rs 10,000 per year on health care.

With the government once again shirking from committing higher budgets to health care, it is tempting to ask: Since there’s money on the table, can entrepreneurs devise privately financed and privately run universal health coverage? Perhaps all it needs is one disruptive idea to show that it’s possible to design comprehensive care outside the government

Country's healthcare providers will spend 57 billion rupees on IT products and services this year, with the salaries of internal IT staff expected to see the highest growth among spending categories.

The healthcare sector in India is currently at a cusp – while, the industry is poised to grow at an estimated annual rate of 19 per cent to reach $280 billion by 2020 with India being recognised as a destination for world class healthcare, it is also facing an unprecedented pressure due to the poor reach of quality healthcare to millions of India’s citizens caused by issues of access and affordability. However, adversity is often also an opportunity.

This predicament has caught the imagination of committed individuals and institutions in both the private sector as well as the government to look for solutions which ensure that the benefits of world class capabilities reach more than just the top 10 per cent of the population. The government is tackling this issue through several policies and tactical initiatives including increasing its budgetary spend on healthcare from the current around one per cent of GDP, designing and implementing models of healthcare financing including social insurance (like the Rashtriya Swasthya BimaYojna), and partnering with the private sector to best leverage its strengths to achieve its objective of ‘health for all’.

In parallel, an ecosystem of innovations for world-class healthcare delivery, driven by private providers, is developing. India is establishing new global standards for cost, quality and delivery, through its breakthrough innovations in healthcare. The last couple of years have seen a rapid increase of private equity and venture capital funds available for entrepreneurs in healthcare, which has enabled scale-up of some new interesting models for providing healthcare.

Apollo Hospitals is spearheading an initiative to link the health records of patients with the Aadhaar identification system.

The hospital group’s Executive Director-Operations, Sangita Reddy, is personally involved in rallying the various industry bodies (FICCI, CII and Nasscom) towards creating a national pool of electronic health records which can be linked to the Aadhaar.

Currently, different hospitals are working with various software firms to create their own system of electronic health records (digital documentation of patient’s medical history). This only leads to islands of automation which do not connect, said Reddy in an interview to Business Line. But when you link the records with the unique ID system (Aadhaar), it creates a nationalised resource pool with data pouring in from different locations.

For instance, a patient may come to Apollo for a particular treatment. But he or she may also go to other medical institutions for other procedures. Having a single unique ID helps integrates across the IT systems of all these institutions; this saves critical time and effort in patient care, said Reddy.

Innovation comes in many shapes and sizes. From creative products to dynamic technology services, HP and its partners lead the way when it comes to bringing great ideas to life. That's exactly what we aim to accomplish in rural India through one of our newest partnerships!

In 2013, HP and SHARE INDIA plan to work together to improve  quality healthcare access in rural areas. SHARE INDIA is a non-government organization (NGO) that's been recognized as a Scientific and Industrial Research Organization (SIRO) by the Government of India's  Ministry of Science & Technology. Based on a signed memorandum of understanding, we will collaborate to deploy HP’s cloud-enabled healthcare solutions in  Andhra Pradesh.  

The new eHealth Center is expected to give close to 20,000 people across 10 villages an opportunity to receive quality diagnosis and treatment from doctors seated at a telemedicine studio in SHARE INDIA - MediCiti Hospital at Ghanpur Village in Medchal Mandal, Ranga Reddy District of Andhra Pradesh.

Patients will have direct interface remotely with doctors through a video conferencing-facility and will be assisted on-the-ground by interns, paramedics and nurses from the MediCiti Institute of Medical Sciences (MIMS). MIMS will also provide weekly supplies of medicines and other consumables to the eHealth Center.

“Over the past decade, [our organization] has worked extensively to understand and resolve the challenges in delivering accessible and affordable healthcare to remote locations. Technology plays a crucial role in facilitating effective and sustainable solutions for this, and our partnership with HP is a significant step towards providing quality medical treatment to the under-privileged in rural India,” said Dr. P.S. Reddy, Chairman of SHARE INDIA.

What's on the horizon? HP and SHARE INDIA are planning to roll-out similar initiatives in other parts of Andhra Pradesh, the north-eastern states of India and Rajasthan.

According to Dr. Jaijit Bhattacharya, Director of Government Advisory for  South Asia HP, the "cloud-based e-health solution is a potential game-changer and reaffirms HP’s vision that innovating technology can strengthen healthcare systems and improve access to medicines, quality treatment and better care.”