Express Healthcare (Vol.12, No.2) February, 2012

VOL.12 NO 2 PAGES 64

Market 71 Conference of IRIA and 17th AOCR held in Mumbai st

Cover Story The Economics of Cancer Care www.expresshealthcare.in FEBRUARY 2018, `50

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CONTENTS Vol 12. No 2, February 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 Delhi Prathiba Raju Design National Design Editor Bivash Barua Asst. Art Director Pravin Temble Chief Designer Prasad Tate Senior Designer Rekha Bisht

THE ECONOMICS OF CANCER CARE It is time for healthcare stakeholders to synergise and strategise to navigate the complex maze of cancer economics to ensure delivery of affordable and equitable cancer care in India | P-20

Graphics Designer Gauri Deorukhkar Artists Rakesh Sharma

POLICY WATCH

MARKET

RADIOLOGY

LIFE

Digital Team Viraj Mehta (Head of Internet) Dhaval Das (Web Developer) Photo Editor Sandeep Patil MARKETING Regional Heads Prabhas Jha - North Harit Mohanty - West Kailash Purohit – South Debnarayan Dutta - East Marketing Team Ajanta Sengupta, Ambuj Kumar, Douglas Menezes, E.Mujahid, Nirav Mistry, Rajesh Bhatkal, Sunil Kumar PRODUCTION General Manager BR Tipnis Manager Bhadresh Valia Scheduling & Coordination Santosh Lokare CIRCULATION Circulation Team Mohan Varadkar

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71ST CONFERENCE OF IRIA AND 17TH AOCR HELD IN MUMBAI

HEALTHCARE SABHA TO BE HELD IN PUNE FROM MARCH 8-10, 2018

RAY OF HOPE FOR ASHA WORKERS IN ASSAM

TRADE AND TRENDS

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IN INDIA, WE AIM TO FOCUS ON PROVIDING HIGH QUALITY CARE

THERE IS AN EXPONENTIAL GROWTH OF SCIENTIFIC KNOWLEDGE IN RADIOLOGY WHICH NEED TO BE EXPLORED

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‘IT WOULD BE TOO EARLY TO MAKE ANY COMMENT ON THE EFFICACY OF THE HIV BILL’

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.

EDITOR’S NOTE

Budget or ‘fudge’it, only time will tell

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inance Minister Arun Jaitley's last full budget before the 2019 general elections seems to be a first step towards universal health coverage for Indian citizens. This is clearly a precursor to Prime Minister Modi's version of Obamacare. Kicking off the health section of the Union Budget 2018-19, the FM said, “Only Swasth (healthy) Bharat can be a Samriddha (prosperous) Bharat. India cannot realise its demographic dividend without its citizens being healthy.” There is criticism that with recent electoral set backs due to farmer distress in the rural areas and a restless jobless urban youth, most Budget announcements this year favoured Bharat rather than India. The sub text to most announcements is the creation of jobs as an additional spin off benefit. There is also an effort to distance itself from the Opposition's criticism of being overtly corporate friendly ('suitboot ki sarkar') at the cost of the common citizen. For instance, the FM prefaces his allocation for an additional ` 600 crore for nutritional support to TB patients at the rate of ` 500 per month during their treatment, with the statement that TB ‘affects mainly poor and malnourished people.’ There is no fault with this rationale. In fact, a focus on bettering health outcomes at the grassroots, including both rural and urban poor, is long overdue. Centres of excellence in healthcare, both in public and corporate, tend to be located in major metros. Most urban Indians tend to have more resources, hence better access to nutrition and preventive health check ups. Most of the salaried population can afford self purchased as well as corporate sponsored/subsidised insurance cover. Thus the FM's announcement to upgrade existing district hospitals in the country and create 24 new government medical colleges and hospitals is a good move to strengthen the health ecosystem in India's villages and district towns, reducing the need to travel to cities for healthcare, except for the very serious cases. It will also address the dearth of doctors and paramedical staff in India, which often hampers healthcare delivery. The FM has also increased the limit of deduction for senior citizen health insurance under Section 80D, from ` 30,000 to ` 50,000 which will enable senior citizens to access more healthcare facilities. But the centrepiece of the budget’s proposals

Even if FM Jaitleyhas rectified the mistakes of Obamacare,will this government have the time to implement Modicare?

for health is the a flagship National Health Protection Scheme, as part of the Ayushman Bharat scheme. Pegged as the ‘world’s largest government funded national health programme,’ it aims to provide insurance cover to over 10 crore poor and vulnerable families, (benefiting approximately 50 crore family members), providing coverage upto ` 5 lakh per family per year for secondary and tertiary care hospitalisation programme. While major hospitals, diagnostic players and insurance companies have hailed these announcements, as more business could come their way, they are cautiously awaiting details of its implementation. Many PPPs have gone south as private players allege that payments from government tend to get mired in red tape, are disputed, delayed and often have to be written off. On the primary healthcare side, the FM committed ` 1200 crore to the existing 1.5 lakh health and wellness centres and expanded their coverage to include non-communicable diseases and maternal and child health services, with free essential drugs and diagnostic services. He also intends to harness the mandatory CSR funds of corporates by inviting them to adopt these centres. As industry scrutinises the finer details, there is criticism that fund allocation to healthcare hasn't really increased that much, with the government merely repackaging old wine in a new bottle and topping it off a bit. For instance, there are indications that Ayushman Bharat will be a consolidation of existing schemes under the Jan Suraksha framework, with existing schemes like the Rashtriya Swasthya Bima Yojana (RSBY) as well as schemes launched by individual state governments under a common umbrella. Funds allocated by the centre for state run health schemes often do not get spent, hence this could be a good way to monitor and re-distribute funds to states and schemes which have a history of using health funding efficiently with maximum proven outcomes. With the traditional animosity between centre and state governments, especially those not of the same political colour as the centre, this could well turn out to be a prolonged turf war. Even if FM Jaitley has rectified the mistakes of Obamacare, will this government have the time to implement Modicare?

VIVEKA ROYCHOWDHURY Editor viveka.r@expressindia.com

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Taking healthcare beyond hospitals Home healthcare has been able to step in to ensure that hospitals are able to take care of their patients beyond the hospital. Dr Gaurav Thukral, Chief Operating Officer, of HealthCare atHOME, gives an insight

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ith disease burden on the rise in India due to ailments triggered by lifestyle changes and geriatric population, the pressure on conventional delivery of medical care systems like hospitals and hospitalisation would be tremendous. One emerging option to ease this pressure is home healthcare. There is a misconception amongst some in the healthcare industry that home healthcare is a competitor to hospitals. But, at the outright, let me say that home healthcare providers instead of competing, support hospitals as a step down care partner. As hospital crowding, bed limitations and burden on doctors increases, home healthcare steps in to ensure that hospitals are able to take care of their patients beyond the hospital. Hospitals now have the option to have their beds available for more patients by handing over post – operation cases or critically ill but stable patients to a partner which continues to provide the patients with quality care at the comfort of their home. Organised home healthcare industry stands as a strong support system for the hospitals owing to their investment in world class training for their staff and high quality clinical set ups made available at patient homes. Along with providing visibility to the hospital beyond the hospital by becoming their extended arm, home healthcare providers also become a mechanism for quick feedback and immediate action on it. The importance of closing the feedback loop has become critical due to the unfortunate rise in mistrust towards hospitals. Also, the general perception about home healthcare services is having a nurse at home or an attendant at home. This is a myth. Home healthcare providers now provide numerous oncology, immunology procedures at home, ICU days at home, emergency handling, care management and are looking after lakhs of patients with a high customer satisfaction rate. With availability of 24*7 remote monitoring systems, leaders of home healthcare industry are also ensuring continuation of expert supervision for the patients from hospital to home. Some sceptics feel that hospitals may not gain financially by sending patients to home healthcare providers. That is not the case. It is just the opposite. Let me illustrate: ICU patients with a prolonged recovery trajectory will generate higher revenue for the hospital in the initial days of hospitalisation as compared to subsequent days – thus, leading to a low ARPOB (average revenue per operational bed). Home healthcare partners can provide step down care right after those high revenue initial days, hence, reducing the ALOS (average length of stay) for patients and resulting in higher ARPOB. Along with being profitable for the hospital, this

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arrangement is more economically viable for the patient as well, as with significantly lower per day cost in case of services like ICU set up at home, their total cost of treatment reduces significantly. This proves the point that home healthcare providers are partners, not competitors to hospitals. Far from being a competitor, home healthcare can actually help hospitals build their brand and expand their reach. Home healthcare is also a solution for handling difficult long-term patients who may cause a lot of non-clinical problems for the hospital. Hence, a home healthcare partner also relieves hospitals of possible legal liabilities owing to complications which may arise due to long-term hospitalisation. More important is patient satisfaction that the hospitals gain by sending patients to their homes with the same medical environment, medical care and attention and the overwhelming joy of being with their relatives and near and dear ones. This satisfaction is not measurable in terms of money; but in terms of the joy and relief that the patients get when they are taken care of at home with no letup in medical care and the assurance that their treating hospital and doctors are just a phone call away. The partnership between hospitals and home healthcare providers is not just profitable for the hospital and the individual patient, but for the country at large. Through this partnership, more number of patients can be treated by hospitals as beds get freed. India needs over 6 lakh+ beds to cater to the country’s growing population. It is impossible to bridge this gap unless there are innovative methods like home healthcare and use of emerging technologies like wearables and remote monitoring. While metros and major cities have

super and multi-speciality hospitals supplementing the efforts of government and medical college hospitals, the pinch is felt in tier II and III cities. One way out is for hospitals in these cities to increase their bed capacity and infrastructure. But that will involve huge capital outflows which many hospitals can ill afford. The pragmatic way out is to extend their reach without building expensive infrastructure with a home healthcare partnership. Patients residing in a tier III city at a distance of around 200 km from a tertiary care centre often discontinue their treatment in the middle due to rising costs and inconvenience of travel. With home healthcare services, step-down care including complete ICU setup can be delivered right at their home at a reduced cost. Along with being a step – down care support system, home healthcare care help hospitals treat lifestyle ailments like diabetes care, post-op care, obesity management and physiotherapy that need personal attention and privacy, pregnancies and post-delivery care. While all this is in existence now, there are unchartered areas where hospitals and home healthcare would have to work in tandem. One is the rise in ailment due to the increase in geriatric population - expected to constitute 11 per cent share of population by 2025. The second is a more worrisome gap in medicare – loneliness. Alarmed at the rise of loneliness among the aged, the UK government recently appointed a ministry for loneliness. This is because loneliness can trigger depression and aggravate existing ailments. These patients need long-term care and can only be managed at home through active support and tie-ups with hospitals. Apart from medicines, these patients need specialised individual care and attention. Treatment in such cases can be successful only when hospitals and home healthcare providers work as partners. In short, home healthcare is a distributed hospital which build the existing capacity in patient homes to take care of infrastructural gaps in existing hospitals. And this infrastructural gap will only substantially grow in the coming years. Already, leading home healthcare providers have successful tie-ups with leading corporate hospitals across the country. Such tie-ups also help improve patient satisfaction since personalised quality care is the key. Add to this are improved safety and comfort for the patients and faster recovery because of familiar environment and proximity to near and dear ones. The bottom line is that hospitals and home healthcare providers should partner in delivering better medicare to the growing demand of a population who benchmark medicine with personalised service.

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MARKET POST EVENT

71st Conference of IRIAand 17th AOCR held in Mumbai The inauguration was graced by Governor of Maharashtra, C Vidhyasagar Rao and members of national and Maharashtra State Chapter of IRIA

Amitabh Bachchan during the inauguration

O

ver 200 eminent speakers from India and other Asian countries congregated at Asian Oceanian Congress of Radiology (AOCR) 2018, Asia’s largest radiology and diagnostic imaging congress. The event held in Mumbai saw attendance from radiologists and diagnostic imaging experts from across the globe.

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The conference began with an inaugural ceremony of the Indian College of Radiology and Imaging (ICRI). Dr Bhupendra Ahuja, President, Indian Radiological and Imaging Association (IRIA), delivered the opening remarks and congratulated the IRIA and AOCR team for organising such a huge convention of top notch radiologists, techni-

cians, and experts from the field of diagnostic imaging. He highlighted the agenda of the conference and shared his insights on the ever evolving field of radiology in India. Dr Vara Prasad, Secretary, ICRI, presented the annual report of the ICRI. He spoke about the new voluntary education programmes started by ICRI and IRIA to promote ad-

vanced learning in the field of radiology which is made available to most professionals and radiologists in India. The function was followed by an award ceremony where many deserving radiologists and researchers were conferred with awards and fellowships. The first day of 17th AOCR 2018 also saw eminent speakers including many interna-

tional experts share global perspectives at the conference. One such session was ‘Liver elastography guidelines and current state’, held by Dr Richard Barr, Radiology Professor, Northeast Ohio Medical University. He discussed the major consequences of liver disease. He informed that the stage of liver fibrosis is important to determine progno-

sis, surveillance, priorities of the treatment and potential for reversibility. He pointed out that multiple elastography techniques are available and that the literature supports the non-invasive use of these techniques to assess liver stiffness. Further, he went on to say that to obtain accurate liver stiffness measurements, adherence to strict protocol is required. Dr Barr also educated the audience about the critical points to be kept in mind while interpreting results and thereby acquiring accurate diagnosis. He also highlighted that both, the patient and scanning factors affect these results. Concluding the session, he elaborated on the multiple ways that can help make radiologists improve imaging results. The inauguration of the 71st Conference of the IRIA and the 17th AOCR was graced by Maharashtra’s Governor, C Vidhyasagar Rao and members of national and Maharashtra State Chapter of IRIA. During the ceremony, Dr Mohanan K, 74th incoming IRIA President, said that the association would always stand by the radiologist members.

The Maharashtra state chapter of IRIA launched the RAKSHA campaign, a nationwide initiative to save the girl child.The campaign was inaugurated by Amitabh Bachchan who has extended his support to the cause. More than 1000 radiologists present at event also pledged their support to the cause

He said that IRIA would ensure radiologists are trained to be the best so that there is no encroachment by 'sonoquacks.' He also appealed to the Governor of Maharashtra to give some clarity on levying GST on radiology equipment. He also opined that there should be zero GST on such equipment as they are life-saving. The Governor praised the efforts of radiologists, and calling them lifesavers. He stated that radiologists play an important role in early detection of diseases and thereby in the reduction of the country's disease burden. He also men-

tioned the urgent need to harness teleradiology, given the lack of radiologists and doctors. He rightly pointed out that as India is predicted to have a huge geriatric population, more than that of the US, there is an urgent need for effective radiology solutions. Further, he urged the radiology equipment players to manufacture advanced radiology equipment in India and reduce costs. He asked Dr Mohanan to make a report on this and promised to take it up with PM Narendra Modi, who is very keen on the ‘Make in India’ initiative. The Governor lastly high-

lighted the skewed sex ratio in the country and the role of prenatal sex detection in this abysmal situation. He also pointed out that female foeticide too remains rampant, and said that the way forward is to change the mindset of the population. Moreover, the Maharashtra state chapter of IRIA launched the RAKSHA campaign, a nationwide initiative to save the girl child. The campaign was inaugurated by Amitabh Bachchan who has extended his support to the cause. More than 1000 radiologists present at event also pledged their support to the cause.

The inauguration ceremony began with Dr Sona Pungavkar, explaining the aim and vision of the initiative. 'Save the girl child' and 'Laadli' are some of the social initiatives to wage a war against female foeticide which aims at protecting, safeguarding, supporting and educating the girl child. Similarly, these radiologists have also joined hands to continue this effort. Pledging his support to the initiative, Bachchan said, “During my TB and Hepatitis B treatment time, I discovered that there was discrimination amongst women with these conditions. Therefore, this subject is very close to my heart. So, when I was approached to support this initiative I couldn’t say no. We need to support all women who face discrimination because of their illnesses and medical conditions. We have to encourage women for early diagnosis of diseases and ensure a secured future for them. We will fight for women of our nation until they are completely empowered. He also shared his willingness to be the voice for this cause.

Q U I Z C O N T E ST IRIA/AOCR 2018 witnessed a lot of interesting activities to engage and educate radiologists across the country. The quiz contest was one such case-in-point. 20 multiple-choice questions were posed to the experts. EXPRESS HEALTHCARE

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FOOD FOR THOUGHT The future of radiology is very bright. Embrace new technology. Artificial intelligence is a friend and not a foe Dr Vijay Rao, President, RSNA

We will see a lot more advances in the field of molecular imaging, targeted MRI and Ultrasonic transducer technologies Dr Vara Prasad, Chief Consultant Radiologist, Global Super Speciality Hospital

The focus on innovations that will change the face of radiology practice in India Dr N Chidambaranathan, HOD & Consultant Radiologist, Apollo Hospitals

Look for the advances in functional MR, molecular diagnostics and BTI. These will further the growth of radiology practice and industry in India Dr Deepak Patkar, Director Medical Services and Head- Dept of radiology, Nanavati Hospital

Radiology is an extremely vast field and hence the way for young radiologists is to sub specialise by getting into smaller areas like neuro radiology, paediatric radiology, interventional radiology in a more detailed way Milind Gune, Consultant, ICRI

Every young radiologist should take a tremendous amount of pride in being a radiologist which today is the central pole of every single clinical problem. He should conduct himself with confidence, self respect and at the same time with great amount of dedication, completely focussing on the chosen subject Dr Shrinivas B Desai, Director, Department of Imaging and Interventional Radiology, Jaslok Hospital

Become clinical radiologists.You should interact with referring physicians and become an irreplaceable part of the team. Try to involve yourself in all imaging modalities, of course, you may want to specialise in one particular field, but also get interested in ultrasound or do interventional radiology Harsh Mahajan, Founder, Mahajan Imaging

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TA K E AWAYS F R O M A O C R 2 0 1 8 We see that the customers coming to AOCR have a desire to change, even though some of them might not have the means to change as of now. They are looking at all the new technologies such as DR in a more aggressive manner. As for the smaller customers, in terms of the size of examinations that they conduct, they might not be able to afford these products. For them, we have interim solutions and we have displayed them here Dilip Bhosale, Country Head -Sales, Agfa Healthcare

IRIA as a gathering has grown tremendously just as the field continues to evolve. This year, the show is even bigger with AOCR happening together, wherein international delegates and experts have joined us. This is not just an exhibition or a conference but a learning platform. People, both radiologists and equipment players, come to increase our knowledge. This year we have also seen some incredible amalgamation of digital technologies wherein people are exploring the potential of AI etc Praveen Rajgopal, VP- MFAPS, India cluster, Carestream

We have received a very warm response at AOCR 2018. In fact, after the launch of one of our products at AOCR this year, we will be having our first installation of our equipment in Navi Mumbai coming March. We have also understood that radiologists from tier II cities are now opting for high-end technology solutions just as imaging centres from metros would do. Tier III radiologists are still opting for low-cost solutions Ratish Nair, CEO, Sanrad

We see a lot of promise in the Indian healthcare market. AOCR 2018 has been a good platform for us to showcase our innovations. In the coming months, we look forward to introduce many of our innovative products in India, as well as looking for strengthening partnerships with the government. We have received a good response from radiologists present at the AOCR conference Chander Shekhar Sibal, Executive VP, Medical Division, Fujifilm

AOCR 2018 has been a great learning experience, especially for post graduate students. On Day 1, there was a very informative film reading session with out-of-the-world cases, which was an eye-opener in many ways. For us, it is also a place to catch up with old friends and share our knowledge Dr Varsha Rathi, Professor, Dept of Radiology, Grant Medical College and JJ Group of Hospitals

At AOCR 2018, we have focussed on the youth. We have therefore, had an e-poster facility for the young students who come to seek knowledge at IRIA conference. We have also started of with a green/ e-conference where we will send out research papers, awards etc. on mail. We have a special mobile app for them and have received a superb response to this Dr Sanjeev Mani, Organising Secretary, AOCR 2018

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GLIMPSES OF AOCR /IRIA 2018

Latest advancements in radiology and imaging were launched and displayed at the event

Knowledge sharing galore at IRIA/AOCR 2018

Delegates and experts interact and network at largest convention of radiologists in the country

Visitors and experts browse through stalls and check out latest advancements in radiology at AOCR/IRIA 2018

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MARKET PRE EVENT

Healthcare Sabha to be held in Pune from March 8-10,2018 THE INDIAN EXPRESS Group and Express Healthcare will organise the third edition of Healthcare Sabha in Pune from March 8-10, 2018. Healthcare Sabha 2018 will bring together policy makers, thought leaders, national and international health organisations, social entrepreneurs, and technology and ancillary healthcare service providers. The first two editions of Healthcare Sabha held in Hyderabad and Vizag provided an excellent platform for researchers, policy makers, healthcare practitioners, public health advocates to share and exchange evidence drawn from research and experiences in health development programmes in India. Over the past two editions, public health experts came together to share their insights on public health policy and its implementation. The first edition was ”Universal Access to Equitable, Affordable and Quality Healthcare Services to All’ while the second edition focused on “Cocreating a Manifesto for a Healthy India.” As India’s public health ecosystem continues to evolve, the third edition of Healthcare Sabha invites public health leaders to work towards formulating a change strategy, built on three principles: Prioritise, Plan and Practise. The central theme of the two day event aims to explore and debate how India can bring in a multi-disciplinary and holistic approach across the spectrum of public health. As in past editions the deliberations of the speakers, panelists and delegates will be compiled into an OUTCOMES REPORT . For more details check: http://healthcaresabha.financialexpress.com/

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FOCUS:CANCER CARE

The Economics of Cancer Care It is time for healthcare stakeholders to synergise and strategise to navigate the complex maze of cancer economics to ensure delivery of affordable and equitable cancer care in India By Mansha Gagneja

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ancer care is an essential component of all health systems. The economic burden of cancer is considerable and is increasing signficantly. According to American Cancer Society Report, the total economic impact of premature death and disability from cancers worldwide was $895 billion in 2008, representing 1.5 per cent of the world’s Gross Domestic Product (GDP). This figure increased to approximately $1.16 trillion as per the World Cancer Report 2014 by International Agency for Research on Cancer. Yet, with only limited knowledge available, we are far from analysing the spendings associated with cancer care. Considering the immense impact of cancer on patients and their families, in terms of physical health and financial health, there is an urgency to identify more evidence about the cost efficacy of cancer care.

The India story With limited sustained funding and only a few centres of expertise in India, the domestic situation is much worse in comparison to the global scenario. Indian Council of Medical Research (ICMR), in its 2016 projection, said that the total number of new cancer cases is expected to be around 14.5 lakh and the figure is likely to reach nearly 17.3 lakh new cases in 2020. Data also revealed that only 12.5 per cent of patients come for treatment in early stages of the disease. The fact that often cancer is diagnosed only at critical stages adds to the already steep economic burden that the ailment poses on the nation. The situation is worsened when people with a genetic predisposition to cancer, for instance incidence of breast cancer in close relatives, also feel no necessity to get screened.

The cost angle Sandeep Kothari, Vice Chairman, Bhagwan Mahaveer Cancer Hospital & Research Centre (BMCHRC) says, “Cancer treatment can turn out to be a

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nightmare in terms of costing. One of the major reasons for this is wide treatment protocols which vary across a broad range, depending upon the site of cancer and the stage at which it is detected. In a country like India where a majority of cases are reported at the third and fourth stage, the treatment can cause a hole in the pocket as most often, depending on their type and stage of cancer, patients will require more than one form of treatment which leads to increase in treatment cost. Dr Ninad Katdare, Consultant Surgical Oncology, Global Hospitals, Mumbai further explains, “Even though numbers of cases are rising at an alarming rate, the per capita income is not increasing proportionately. Nor are the patients from low socio-economic strata able to afford insurance. A s urvey done at All India Institute of Medical Sciences (AIIMS) in 2011 among patients with the most prevalent cancers like head and neck, cervix and breast reported that the average monthly per capita income of households

was `1749. Half the households had monthly per capita income of less than `1000.” Another expert, Dinesh Madhavan, Director Healthcare Services, HCG Enterprises pointed out a few other factors, including lack of domain specific practice among most centres and minimum focus on innovation which contributes to rising cost of cancer care. He elaborates that due to lack of newer and better indigenous technologies for cancer management, most of it has to be imported, thus increasing dependency and multiplying cost. Zoya Brar, Founder & MD, CORE Diagnostics also highlighted, “The recent years have seen a major leap in developing technologies to screen for and diagnose various cancers. Advances in pathogen detection, imaging and even personalised medicine treatments have unfortunately also added to the rise in the cost of cancer care in the country.” Moreover, in a nation like ours, insurance penetration is relatively modest and most of the medical aids involve high out-ofpocket expenses. This has a mul-

tifold negative impact on the financial situation of any cancer patient adding to the existing loss of productivity due to the disease

Loss of productivity Although the cost associated with treatment of cancer is predominant, another considerable economic impact of cancer is in terms of loss of life and productivity. Thus, there is an urgent need to come up with effective measures to battle this beast. Fortunately, the multi-faceted nature and the magnitude of the problem has caught the attention of healthcare stakeholders.

Collaborations to conquer cancer The loss of productivity and life can only be managed by innovation and extensive research, but escalating costs of treatment can definitely be handled through joint efforts put in by multiple sectors. Agreeing with the idea, Madhavan shared that the way forward in cancer lie

in meaningful collaborations between public and private enterprises or between private enterprises. The benefit of this and its aggregation will ensure that cancer treatment is addressed appropriately to create better access and outcome that leads to a better quality of life. He opines, “The next few years of collaborative work will need to be in research, centralised physics, innovation, sharing of resources, protocols, data analysis, early detection, precision medicine, empathy and accessibility. If we ensure to work together, the current cancer burden of over 1.2 million plus newly diagnosed cancer patients can be better managed and ensure the quality of life. If not, the burden of these 1.2 million patients and those already under treatment will be a stark reality.”

Empowering the public sector In 2011, World Bank reported through World development indicators that India spent an estimated 3·9 per cent of its gross domestic product (GDP) on

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healthcare (both public and private funding) and only 21 per cent of which was contributed by the public sector. Though the contribution is relatively low, the sector can be revitalised to improve cancer care significnatly. On the positive side, the Government of India has instigated some commendable initiatives, for instance the National Cancer Grid (NCG). NCG, funded by the Government of India through the Department of Atomic Energy, is amongst the largest cancer networks in the world. It aims to work towards uniform standards of care by adopting evidencebased management guidelines, which are implementable across these centres. Dr Katdare also added, “This plan is to bring parity of cancer treatment in various tiers of the society and provide uniform cancer in all parts of the country. The public domain in the form of the regional cancer centres like Tata Memorial Hospital, WCI Adyar, RCC Trivandrum etc are also doing great work. They are also establishing many other branches of Tata Memorial Hospital in various parts of the country.” Other central schemes to financially support specific population groups include Health Minister’s Cancer Patient Fund (HMCPF) is for patients living below the poverty line; Health Minister’s Discretionary Grants to assist poor patients and Central Government Health Scheme (CGHS) for retired Central Government employees & dependents. Even railways offers completely free travel to cancer patients and air concession of 50 per cent is offered to patients traveling for treatment. Kothari also highlights, “Medicines used for the treatment of cancer are highly expensive and it is extremely difficult for many patients to afford them. In addition to opening exclusive cancer centres across states, the Health Ministry is also planning to reduce the cost of expensive medicines, while putting the least pressure on pharma companies in terms of the price margins. This model will result in the government’s own retail system for cancer drugs, like the Jan

Aushadhi stores, where generic medicines are sold at much lower prices compared to the branded

ones. This way the government plans to ensure availability of quality medicines at affordable

prices to all’. Also the government has decided to extend CGHS kind of model to other

cancer patients as well.” V Thiyagarajan, MD, India Home Health Care also informed about the

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cover ) recent developments saying, “Niti Aayog recently has collaborated up with state governments with an aim to improve healthcare delivery. There has been a push for state governments to rely on public-private partnerships (PPP) to gather funds for public health. Consequently, there are increasing number of initiatives being brought about with an aim to improve infrastructure and increase awareness to ensure early detection of cancer.” Though the government is putting in all these efforts through initiatives and schemes, there is still a long way to go. Dr Katdare suggested, “The government needs to improve the amount provided for treatments in the government schemes like MJPJAY in Maharashtra, which will make the option economically more viable to private hospitals and increase the uptake of these schemes in private hospital, thus increasing the amount of patients who can be treated in these hospitals.” Dr Vikas Goswami, Senior Consultant, Dept of Medical Oncology, Fortis Hospital pointed out, “The biggest public sector contribution should be to increase universal insurance for cancer care and increasing the GDP in healthcare.”

The role of the private sector India has come a long way from where it was two decades ago. But many challenges are yet to be addressed. The private sector, being a vibrant force, accounts for 82 per cent of the total $30.5 billion health sector expenditures in 2003 according to one reported survey. Taking into consideration the share held by the sector, the role of the private sector is very crucial. Kothari highlights, “In the private sector, many not for profit organisations like the Indian Cancer Society, Mumbai and Cancer Care Wing managed by Bhagwan Mahaveer Cancer Hospital & Research Centre, Jaipur are working towards spreading awareness, detection and cure of those who are affected with the disease. These not-for-profit organisations conducts early cancer detection camps especially for

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LEARNINGS FROM THE GLOBE In the US, total healthcare expenditure is pegged at $3.3 trillion and is more than 15 per cent of its GDP in 2016. Back in 2010, cancer care only constituted $124 billion dollars. Similarly, in the UK, the NHS reported that the total cancer care expenditure was around 5-6 per cent of total health spending. While many argue that increasing care treatment costs could become responsible for increasing healthcare spending, it would be unwise to deny that such spending has resulted in better infrastructure and access to better treatment methods. As each country has its own legal hurdles and policies for healthcare, strategies to tackle cancer vary greatly. With the number of uncertainties surrounding India’s healthcare ecosystem, a top-down approach is needed where the government intervenes at every level to work towards improving infrastructure and more importantly, making such facilities more accessible V THIYAGARAJAN MD, India Home Health Care

As per the report of Euro Pancreatic Cancer Index (EPCI) 2014, published by the Sweden-based research organisation Health Consumer Powerhouse (HCP)Netherlands comes out top with 879 of a possible 1,000 points, followed by Denmark (872), France (812), Ireland (807) and the UK in fifth position. Reason for this is very high quality of cancer research. In Finland, there is a long tradition of collecting samples in bio- banks, which makes genetic information readily accessible. These samples can be linked to comprehensive digital databases of donor health data, which benefits cancer research enormously. Bio-bank samples can be used, for instance, to examine the molecular features of cancer cells in order to find out which treatment works best for different types of cancer. With the help of this model, Finland, which was way behind many other European countries in cancer treatment, has come a long way and is now leading in cancer research and treatment. This research model proved a boon for the patients who were in distress due to higher cost of treatment. In a country like India where health insurance system is still in its initial phases of popularity, majority of patients settle their bills in cash. The research model adopted by countries like Finland can help enormously in reducing the treatment cost. More and more researches lead to better and cheap methods of treatment. Also, doctors/ clinicians, with the help of research papers, can identify the problem at the right stage leading to lesser diagnostics and investigations SANDEEP KOTHARI Vice Chairman – Bhagwan Mahaveer Cancer Hospital & Research Centre (BMCHRC)

Most countries that are ranked by WHO in the top 15 countries in health care rankings either follow the Bismarck or the Beveridge Model. Hence, they find themselves rated so, since both of them follow a policy that falls under taxation, National Health Service, mandatory Insurance and public and private service with public taking the lead . India is a highly populated country with a WHO rating below 150. So it will need to study these models to find out how the public enterprise and the private enterprise have worked together to ensure better care and quality of life. Any country that has an over dependency on private health is bound to suffer and so is the case with public health dependency. There needs to be a fine balance between these two like the Yin and Yang. DINESH MADHAVAN Director Healthcare Services – HCG Enterprises

underprivileged and also provides funds for the treatment. As per its latest Annual Report, BMCHRC has spent approximately 2.4 crores in the last financial year on the treatment of those patients who can’t afford treatment and belongs to the weaker section of society. Similarly, Indian Cancer Society has spent around 87.13 crores on the treatment as per its Annual Report of 2016-17. These initiatives are good but there is a dire need that other Private players also joins in and create a pool which can be used for the treatment of cancer affected patients. Dr Katdare also adds that trust aided private hospitals need to be regularised and a regular audit of number of patients treated by them needs to be done. This will improve the amount of patients treated. Additionally, a certain percentage can be earmarked for superspecialties where treatment is costly like cancer and also as part of Corporate Social Responsibility for treatment of poorer patients. For eg. In global hospital, we have created affordable packages for cancer surgery wherein the in and out package for an uncomplicated stay is almost 30 per cent less than the a-la-carte charges. Suresh Ramu, Co-founder & CEO, Cytecare Hospitals mentioned about another important segment,"Diagnostics sector plays an integral element in providing cost efficiency during both diagnosis and treatment. There is a need to diagnose effectively with limited set of diagnostic tests rapidly so as to start the accurate treatment immediately. And even though there are vast innovations in the technology which can reduce the burden of the disease through precision and quality, these personalised treatments are expensive and frontloads the cost involved. Governance of care is an important aspect through which the cost of treatment can be reduced. We have deployed a multi-disciplinary tumour board which reviews all the patient treatments, and the plan of treatment is evaluated against the global standard to prevent recurrence. If the

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recurrence of the disease is minimalised or managed, it could bring substantial reduction in the cost of cancer care."

sector. Considering India’s vast population, crowdfunding may also soon be identified as one of the key measures that can be put

to use manage cost of cancer treatment. Contribution towards building a pool could substantially reduce the economic

burden of cancer. With Government aiming to bring down the cost of entire healthcare delivery system and cancer being a major

concern on the list, we hope to soon reach the affordable cancer care in India. mansha.gagneja@expressindia.com

Ramping up insurance Despite these improvements, one major lag remains in the insurance sector, with India’s current insurance penetration rate standing at 3.42 per cent, which is far below the global average of 6.2 per cent. Moreover, cancer insurance, being a novel form of coverage, is a relatively new trend in the insurance industry. Even though it aims to mitigate the cost of cancer treatment, the market share is very less. Rakesh Wadhwa, CMO and EVP - Strategy & Retail Assurance, Future Generali India Life Insurance Company informed, “Insurance works on the fundamental principle of pooling of risk. With pooling of risk comes the effect of economies of scale. A large insured population shall provide an opportunity for providing health care for masses at an affordable cost. A large insured population shall also help health care providers to provide quality health care at multiple locations.” He further suggests,“Considering the population size, economic profile and limitation of healthcare infrastructure, In my opinion we need a system which is mix of government support and active participation from private healthcare provider. The government can come with universal health insurance scheme for all citizens covering major critical illnesses. The base level of cover can be provided free for people in economically weaker section of the society. The insurance companies can provide a top-up cover insurance to citizens charging affordable premiums and ensuring quality health care.” Examining the industry perspective, it is evident that the nation is far from achieving affordability and accessibility when it comes to chronic diseases like cancer. Having said that, we sure are on the path and bringing in cost efficiency, but requires effort from all stakeholders, be it government, hospitals, pharma companies or the insurance

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I N T E R V I E W

Bringing cost efficiency in cancer treatment is the need of the hour In a wide-ranging interview, Dr Sajjan Rajpurohit, Senior Medical Oncologist, Rajiv Gandhi Cancer Institute and Research Centre (RGCIRC) talks about the cancer scenario in India to Prathiba Raju. Explains that late detection, lack of awareness and affordable care are the main reasons for the high cancer mortality rates in the country

Cancer has taken centre stage and is in an upsurge, with more and more people being detected with the disease, still we don't have enough oncologists. Why do you think there is a dearth of specialists in oncology? The value of detecting cancer early is significant. Although the situation has improved in recent years, India still has one of the worst records for both identification of cancer and survival from it. Late detection, lack of awareness and affordable care are the main reasons for the high cancer mortality rates in the country. However, awareness on cancer has improved from what it was ten years ago, but still much more needs to be done. The number of cancer cases are burgeoning due to increased urbanisation, air and water pollution and change in lifestyle, like increased use of tobacco, preservatives and processed food, use of alcohol, tobacco, obesity, etc. As per a report by EY, the prevalence of cancer in India is expected to increase from an estimated 3.9 million in 2015 to an estimated 7.1 million people by 2020. There is a significant dearth of well-trained oncologists across the three streams – medical, surgical and radiation oncology. India has

only about 1500 medical oncologists and we would require atleast 10,000. Atleast one medical oncologist is needed for 100,000 people and we have a huge gap. Many medical oncologists are present only in the urban areas or tier I cities. In tier II and tier III cities, it is difficult to get a medical oncologist and we don’t have enough surgical and radiation oncologists. Cancer being a chronic disease, there is an urgent need for increased oncologists’ presence in tier II and tier III cities. For example, in Uttar Pradesh, apart from Lucknow, almost all other districts lack optimal oncology facility, even AIIMS in Jodhpur does not have medical oncologists. Government needs to lay huge focus on delivering the oncology facility atleast in tier II and tier III cities.

Apart from other non-communicable diseases, cancer treatments should be given an impetus and more generous funding by the central and the state governments

Can you tell us how the oncosurgery has developed in the recent years and what are the innovations which can be expected in the next five years? As setting up a cancer hospital is capital-intensive, we have only about 10 to12 cancer centres of excellence pan India which provide gamut of quality cancer treatment matching the world class cancer centres.

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cover ) With few centres of excellence, many patients from the rural, interior towns and district wait for months together to get the treatment. In certain cases, a Stage I cancer patient is treated when it reaches Stage 4 and becomes incurable and their lives are being put at risk. For example, in AIIMS Delhi, the average time to begin a radiation is four months due to huge patient load. There has to be a sense of urgency and prompt diagnosis is vital in cancer treatments. If the treatment duration extends, it means increased rounds of chemotherapy, with more side effects. The state government should ensure that a financial aid be given to the cancer patients. Though some states are doing it, but it should be made mandatory. Do you think precision medicine for cancer care will be the way forward in cancer treatment? Precision medicine is a personalised medicine. We get information about genetic changes in the tumour, which can help decide which treatment will work best for an individual. The doctors will go for next gen sequencing, check how the proteins are formed and study the epigenetic changes and various other factors, which make the tumour behave in a particular manner. So, it helps them to design specific treatments for certain forms of cancer. Mostly, people with breast, lung cancers usually have their cancers tested for certain genetic changes when they are diagnosed. Many cancers which have high incidence in India like gall bladder, stomach and pancreatic cancers is still evolving. Many oncologists are trying to move towards understanding the basic biology of cancer patients. Instead of focussing on disease, we are now more

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focussed on patients. It helps us to detect how and whether chemotherapy will work for a patient or how much effect a drug will have on the patient. Precision medicine helps a doctor to be more aware of the biology of the disease. Treatment using precision medicine can be expensive. It is beyond the reach of 90 per cent of our population. How are various sectors working towards bringing in cost efficiency right now? Bringing cost efficiency in cancer treatment is the need of the hour, as this disease as huge financial implications in an individual and his/her family. Apart from other non-communicable diseases, cancer treatments should be given an impetus and more generous funding by the central and the state governments. On an average, the cost of standard cancer treatment in a private hospital is ` 5 to 10 lakhs. If we involve precision medicine, newer immunotherapy drugs cost will go upto ` 1 crore. Tell us about the myths which exist about chemotherapy? Yes, a number of myths do exist about chemotherapy. I have seen patients who are scared, angry and try to walk away before the treatment. Chemotherapy is nothing but the drugs which are infused into a patient which work against the cancer cells. As they are able to inhibit the rapidly growing cells, they have growth impairment of the bone marrow cells, hair cells and cells of the gut. Chemothrapy induces alopecia (hair loss), alterations in the mouth, lowering of immunity and blood platelets, but all those side effects are amply studied. In the past one decade, there has been huge advancements. Many chemotherapy drugs are in part designed to prevent nausea and

vomiting, or reduce their severity. Many patients think that they have to be admitted to hospital, but nowadays many chemotherapy drugs are taken orally or as an injection. There is no extended hospital stay, they can continue with their professional lives. Tolerating chemotherapy has become easier. Many doctors also help the patients to reverse side effects. For example, many patients worry about alopecia. Now, we have devices to prevent alopecia. But, the flipside of chemotherapy is that it is less precise as it acts upon 40 to 50 percent of the tumours and the rest will require subsequent drugs. That is why we are moving towards more precise and target-oriented drugs. Nevertheless, chemotherapy is a very important component of cancer treatment, especially in advanced stages. Can you give us details about the research you are involved in? With human effort, we have come over many deadliest of communicable diseases like plaque, polio and small pox. To a large extent, people are able to survive even HIV, what is ailing the human race is cancer. So, we need to really focus on our research over cancer. We have long recognised that cancer occurs mostly in people who have less immunity. That is why geriatric population and people who had transplants and are under immuno suppressants get cancer. However, in the last five years, there has been an increase in the research on the drugs of T cell as they directly go and kill the cancer cells. Currently, with a team of clinical oncologist and basic researchers, I’m working on a research to find, which all are immunogenic tumours in the body. Besides, we are also planning on a project with the Indian Council of

Medical Research (ICMR) as well as private bodies where we would be doing research on Chimeric Antigen Receptor (CAR) T cells. Tell us about the role of immunotherapy in cancer and the cost involved? I have access to newer immunotherapy drugs. So, my patients get the advantage out of it but the cost of drugs is a huge obstacle. A month’s therapy could cost around ` 3 to 4 lakhs. If we see the global scenario of immunotherapy, five years down the line, we will have better drugs and lesser use of chemotherapy to control and cure cancer. For those immuno drugs to be affordable in India, it will require atleast another decade. If the government is able to understand and try to put a research impetus by giving grants for immunotherapy research in cancer then it might be availed in our country much earlier. Apart from immuno therapy, there is targeted therapy which has been there for eight years. In 2000, the first targetted oral drug called imatinib was launched for chronic myelogenous leukemia. Since then, we have 60 to 70 oral targeted drugs across various malignancies. So, we are not only moving ahead in the immunotherapy, but we are making our chemotherapies more safer and tolerable, also moving towards getting oral drugs, which can treat cancers like chronic myelogenous leukemia, acute lymphocytic leukemia, multiple myeloma. Our medical management of cancer is becoming more precise and target oriented with more use for immunotherapies and lesser use of chemotherapies. How can insurance as a sector play a role in making the patient care more affordable and accessible? Unfortunately, many of the insurance players are

excluding the cancer treatments’ basic health packages or they cover them inadequately. Many of them refuse to pay up for cancer treatments of people who have smoking habits, or tobacco use. There needs to be a government insurance with a corpus of ` 5 to 10 lakh for a standard cancer treatment. Government panels like Central Government Health Scheme (CGHS,) Employees State Insurance Corporation (ESIC) are tremendously helping people on cancer treatment, but only 10 per cent of them are covered by it. We need a universal health insurance against NCDs. Of late, the government’s move on the regulation of drugs is benefiting lot of people, but the government should ensure that the generic drug supplies are of quality and must not be affected due to price control. The government and private sector should work in tandem. While government helps the public with the insurance, private sector should have packages, by which they can accommodate people for cancer treatments immediately. The model of the US and the UK can be referred, where all the cost is borne by the respective state governments. How RGCIRC is different from other cancer institutes? Rajiv Gandhi Cancer Institute & Research Center (RGCIRC) is one of the largest pioneer private cancer institute in India, which has treated almost two lakh cancer patients for the past two decades. There is an element of empathy towards the patients and the family. The cost here is affordable. Moreover, all advanced treatments which are available globally are rapidly adopted by the centre. prathiba.raju@expressindia.com

POLICY WATCH

Ray of hope for ASHAworkers in Assam National Health Mission, Assam, Health & Family Welfare Department, Government of Assam, has recently streamlined the compensation of ASHAs in the state by implementing an online payment and monitoring system. Excerpts from a case study

B

eing a service organisation meant for delivery of health services through a force of more than 22000+ employees, employee motivation and retention of both service delivery and allied programme management staff is a priority area.

processes in addition to rectification of systematic issues. The processes for this initiative were initiated from April 2015 and the system was implemented from November 2015.

Action plan for ASHAs

The following issues hindered proper implementation of ASHA programme in the state: â—— ASHAs are not aware about the list of activities for which they are entitled for incentives: There are around 48 activities through which ASHAs could claim incentive by performing their duties. But, during round of interactions with ASHAs it was observed that, most of ASHAs were not aware about the activities to be performed. ASHAs were performing only few activities and most of activities remained unaddressed which hampered the overall implementation of various programmes under National Health Mission.

Accredited Social Health Activists (ASHAs) is the backbone of healthcare system at grass root level. At present 30,619 Rural ASHAs and 1,336 Urban ASHAs are working in the state of Assam. ASHA receives incentive for the activities they performed. Regular enhancement of capacity, proper monitoring of activities and timely payment of incentive are the basis for success of ASHA programme. However, due to various field level as well as systematic issues, ASHA programme was not running smoothly including irregular payment of incentives which resulted grievances among ASHAs and de-motivated them and large sunk of this huge work force became inactive. Most of the ASHAs

ASHAs at a training workshop

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Challenges faced before deployment / implementation

ASHAs on an imunisation drive

were even unaware about their entitlement for various activities. Lack of proper guidelines deprived the ASHAs from their due. Due to absence of structured monitoring system quality of services and capacity building programmes were compromised. Absence of proper monitoring system made it difficult to assess the performance of ASHAs.

ASHAs were performing only few activities and most of activities were remained unaddressed which hampered the overall implementation of various programmes under National Health Mission. There was an urgent need to streamline the entire ASHA programme to address the field level issues. After rounds of interaction with ASHAs and

other stakeholders and through field visit by state level officials, field level issues related to ASHA programme were listed out and a comprehensive action plan was prepared to streamline the entire ASHA programme. Use of information technology was taken as the platform by implementing single window payment system to streamline the

â—— There were no comprehensive guidelines: Absence of comprehensive

guidelines on payment of incentives to ASHAs created a lot of confusion. Activity wise guidelines were issued time to time from various programme / components. Even all guidelines were not disseminated to the grass root level. Lack of clarity on guidelines and supporting documents to be submitted along with the claims witnessed diversified system in each block empowering accounts managers to decide the supporting documents to be submitted compromising the overall objective of the programme. Even rate of incentives paid was not uniform as newer guidelines was not peculated down to grass root level. Due to lack of proper guidelines, verification/ validation of claims were also not done properly by respective programme officer which raised question on accountability on the system.

assess the performance of ASHAs: Manual system was implemented for the entire process. There was no mechanism to assess the performance of ASHAs. It was difficult to find out good performing ASHAs, poor performing ASHAs and non-performing ASHAs. More than 5,000 ASHAs were not involved in any activities which deprived the entire population covered by those ASHAs from healthcare services. Programme officers were unaware about the performance of various activities and due to this reason most of the activities were unaddressed and ASHAs could not earned as per expected level. ◗ Lack of digitised ASHA database: There was no database covering all ASHAs. Only basic information of ASHAs was captured through Mother & Child Tracking System (MCTS) which was also not updated. It leads to improper planning and implementation of the programme.

Home based new born care (HBNC) voucher distribution

◗ Complex system of incentive claims by implementing multiple claim forms: Incentive claim forms were developed for each activity separately and most of the claim forms were very complex for ASHAs to fill up. Verification of claim forms and documents became tedious and time consumption job for the accounts persons. ◗ No specific time frame for receipt of claim and release of payment resulting irregular and delay in release of payment: Timeframe for submission of claims and release of payment was not specified and accountability was not fixed at any level. Irregular and delay in release of payment was the major cause of grievances of the ASHAs. During field visit by state officials it transpired that neither ASHAs were not submitting claims regularly and timely nor account managers were releasing payments as accountability was not fixed. ◗ Multiple window payment system: As ASHA incentives were approved under different programmes, so payments were released by different pro-

◗ Quality of ASHA trainings: Though regular trainings were organised for ASHAs as per guidelines provided by Government of India, but question of quality of training and impact of training was always questioned. Proper system for assessment and monitoring of training was not in place. Impact of trainings was also not assessed.

Process followed for deployment / implementation

Home visit by an ASHA

gramme officers. ASHAs used to approach each programme officers to submit claim forms, enquire about status of approval and collect separate cheques from each programmes. It was a tedious job for the ASHAs and they have to travel to Block PHCs frequently. Excuse of insufficient fund always resulted prolonged

delay in release of genuine entitlement of ASHAs. Due to this complex payment mechanism, ASHAs were not interested to perform activities with smaller amount which compromised the overall performance of the programmes. ◗ Lack of transparency in the payment system:

Interaction with ASHAs with the accounting staff was not formal. There were complains regarding issue of red tapping and corruption. In most cases, programme officers were also not involved for verification of claims by ASHAs. ◗ Lack of monitoring system to

◗ Development of comprehensive guidelines: Comprehensive guidelines on payment of ASHA incentives was developed covering all programmes and all 48 activities were to be performed by ASHAs. The guidelines was developed in consultation with all stakeholders including ASHAs, programme officers, accounts officers etc. Eligibility criteria, claim methods, rate and supporting documents to be submitted for each activity was clearly listed out in the guideline to ensure uniform

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POLICY WATCH system throughout the state. Guidelines were translated in all local languages like Assamese, Bengali, Hindi, Bodo and English and ensured that it is made available with all ASHAs, all accounts persons and all programme officers. Distribution mechanism of the guidelines up to ASHA level was properly monitored and documented. All old guidelines were inactivated by issuing order to avoid conflict. ◗ Implementation of master claim forms: Master claim form was developed covering all activities which simplified the claim process. It was also translated in all local languages and made available in sufficient quantity. ASHAs found it simple to fill up the claim form as only number of claims to be mentioned. Name of the activities and rate were pre-printed which reduces the work and minimised mistakes. Implementation of Master Claim form also simplified the work of accounts persons and streamlined the entire process. ◗ Implementation of single window system for all claims: Single window system for submission of claims was introduced so that ASHAs need not require approaching each programme officers separately for submission of claims. ASHAs need to submit all claims in the Master Claim Form and submit it to Accounts Manager. ◗ Fixation of accountability for verification of claims: After receipt of the claims through single window system, the claims are verified by the respective programme officers. It raised accountability and ownership of the programme officers on their respective programme and to ensure proper verification and validation of claims. ◗ Fixation of time frame for submission of claim and release of payment: Fixed time frame was defined and notified for submission of claim, verification of claims and release of payment. The objective was to ensure timely and regular release of

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helped programme officers for proper implementation of the programme. ◗ SMS-based alarms: The system send automatic SMS to ASHAs during receipt of claim, approval and release of payment to ensure transparency in the system. ◗ Categorisation of ASHAs based on performance: ASHAs are categorised as good performing, poor performing and non-performing based on claims submitted. It helped to identify the good performing ASHAs for nomination of awards. Similarly, non performing ASHAs were identified, motivated, re-oriented to improve performance.

payment to ASHAs. Timeframe was finalised and notified after due consultation with all stakeholders. ◗ Opening of bank account of all ASHAs: It was ensured that, bank accounts of all ASHAs are opened and registered and validated through Public Financial Management System (PFMS) to ensure authenticity. ◗ Development of online ASHA payment and monitoring system: Online ASHA Payment and Monitoring System was developed in open source platform using the in-house capacity of National Health Mission, Assam. The system was developed under 'Health Services Monitoring System' and hosted in the NHM, Assam server. The objective was to use the power of information technology to create comprehensive ASHA database and streamline ASHA payment and monitoring system. Claims submitted by the ASHAs are captured in the system and acknowledgements are sent to ASHAs through SMS. Information of approval and release of payment through DBT is also communicated to ASHAs through SMS. This transparent system streamlined the ASHA pay-

ment system by ensuring timely release of payment and ASHAs are relived to visit accounts persons. The system also identified good performing, poor performing and non performing ASHAs. Activity wise report up to ASHA level helped the programme officers for proper monitoring and implementation of the programmes. The system was integrated with PFMS portal for release of payment to ASHAs through DBT. ◗ Monitoring of quality of ASHA trainings ASHA database was created with all vital information of ASHAs along with bank account information, mobile number, photographs etc. The system is also used for monitoring of capacity building workshops of ASHAs. Pre-assessment and post assessment findings of each ASHA is monitored through the system to evaluate quality of trainings.

Innovative aspects of your project / activity ◗ Implementation of single window payment system: one of the major objectives of this approach is to implement hassle free single window ASHA claim system. Development of comprehensive guidelines covering all programmes and im-

plementation of innovative Master Claim form simplified and made the system hassle free. ◗ 100 per cent Direct Bank Transfer (DBT) mode payment: One of the major strategies of the system is to implement 100 per cent DBT mode payment. The ASHA Payment system was integrated with PFMS to ensure 100 per cent DBT mode payment to ensure transparency in the system and ASHAs need not required visiting accounts managers and standing in queue for collection of cheque. ◗ Use of power of Information Technology for development of ASHA Payment System: ITbased online system empowered proper monitoring of claim and release of payment. Now, account managers cannot keep the payments pending which is reflected in the dashboard. Activity wise performance could be monitored and tracked at all level (state, district, block, sectoral, SC and ASHA level) by click of a mouse. The system also generates alarm if payments are made more than normal level allowing the higher level authorities for proper monitoring of the system. Dashboard and different analytical reports

◗ Categorisation of activities based on performance: Activities were categorised based on performance by ASHAs. Low performing activities were identified and causes of poor performance was analysed and necessary strategies adopted to improve performance.

Solution / technologies implemented ASHA payment and monitoring system was developed using open source technology. The system has been developed and implemented using in-house capacity of NHM, Assam and hosted in the NHM Server. The system is developed under secured user login and role-based user access is provided to the different users. Following modules are implemented: i) ASHA Master Database: ASHA database was created with all vital information of ASHAs along with Bank Account information, mobile number, photographs etc. ◗ Incentive claim: Information of incentive claims by ASHAs is captured through this module. Automatic SMS is delivered to ASHAs on submission of claims in the system. ◗ Approval of claim: Information of approval of claims is captured through the system. automatic SMS is delivered to ASHAs on updating of approval.

POLICY WATCH ◗ Payment process: After approval of the claims, payment process is generated to enable payment through PFMS in DBT mode. Automatic SMS is delivered ASHAs after release of payment.

sharp increase of average monthly income of ASHAs from ` 1188 in 2014-15 to ` 4326 in 2016-17. ◗ Timely payment of ASHAs: ASHA payment system has been streamlined and monthly payment is released to ASHAs as per fixed time frame. All backlog payments were identified and cleared within three months from the date of implementation of the system. Now, there is no complaint of delay of payment. Now, ASHAs used to submit claim on time as non submission of claim by ASHAs are also categorised as non performer.

◗ Monitoring of ASHA trainings: The system is also used for monitoring of capacity building workshops of ASHAs. Pre-assessment and post assessment findings of each ASHA is monitored through the system to evaluate quality of trainings. ◗ Dashboard: Dashboard to highlight the ASHA payment system. ◗ Analytical reports: Different customised analytical reports are generated from the system. State, district, block, sectoral, sub centre and ASHA wise reports can be generated. There is option of generation of drill down reports from state level to ASHA for each activity. Activity wise performance reports are also available. Report of good performing, poor performing and non performing ASHAs can be generated in mouse click.

Comparison of the pre-deployment with post-deployment scenario Highlighted comparison of predevelopment with post-development scenario of the system: i) Before implementation of the system in 2014-15, average monthly income per ASHA was ` 1188 in 2014-15. After implementation of the system it has increased to ` 4326 in 201617. ◗ Before implementation of the system, ASHAs were not aware about the list of activities for which they are entitled for incentives. Now all ASHAs are aware about the list of activities for which they are entitled for incentives. ◗ Multiple forms used for claiming incentives for different schemes before implementation of the system. Now, single Master Claim form is used for all activities. ◗ Before implementation of the system, multiple window pay-

◗ 100 per cent DBT mode payment: Now, 100 per cent payment is made to bank account of ASHAs through Direct Benefit Transfer only. More than ` 150 crore payment has been released to ASHAs through this system.

Swacchata initiative by ASHAs

ment system was followed, i.e., ASHAs used to approach each programme officers to submit claim forms, enquire about status of approval and collect separate cheques from each programmes. But, after implementation of the new system, 'Single Window System' has been implemented. Now, ASHAs submit all claims together using single master claim form and need not visit to any person as the amount is directly transferred to bank account.

for doubtful payment cases.

◗ There was no system to track good performing, poor performing and non performing ASHAs. Now, list of good performing, poor performing and non performing ASHAs could be generated in a mouse click.

◗ Interaction with ASHAs with the accounting staff was not formal. Now transparent system implemented by sending automatic SMS to ASHAs.

◗ There was no method for analysis of activity wise performance. Now, activity wise performance can be analysed automatically from the system. ◗ There was no method to check over payment to ASHAs. Now, alert messages appears

◗ Before implementation of the system, there was no fixed time frame for receipt of claim and release of payment. After implementation of the system, fixed time frame developed for receipt of claim and release of payment followed. ◗ Issue of regular non payment was major concern before implementation of the system. Now, payment is regular throughout the state.

◗ Issue of red tapping and corruption offend complained. Now, after implementation of the transparent system, it has reduced substantially.

Benefits derived from the solution implemented ◗ Increase of income of ASHAs: Exceptional outcome of this initiative witnessed

◗ Free from non performer: Around 5000 non-performing ASHAs were identified and converted to zero non performer within two years through motivation, reorientation and replacement. It could be achieved through monthly follow up of non performing ASHAs from the report generated from the system. ◗ Transparency in the system: The major achievement of the system is to establish transparency and accountability in the system. Interaction of ASHAs with accounts persons minimised by implementing single window system. Substantial reduction in issue of red tapping and corruption. ◗ Structured monitoring: Using the alerts and reports, now the administrators and programme officers are more empowered for monitoring. Using the analysis reports and alerts, instances of overpayment to ASHAs were tracked and those were recovered after thorough investigation.

Potential for replicability arising from the success of your project/ activity ◗ Cost effectiveness: The initiative is cost effective. The entire

project was managed from the available fund and existing human resources without any hassle. The system was developed using in-house capacity of National Health Mission, Assam using open source technology and it is hosted in the NHM Assam server, so no extra cost was involved. ◗ Customised solution: The system was developed within reasonable time of three months despite several technical issues like integration with PFMS, validation of bank accounts etc. As the system is developed in-house, so it is easy to customised and include new features without any problem. New customised reports could be included as per requirement. ◗ Utilisation of PFMS platform for DBT payment: As PFMS portal is utilised for payment to ASHAs through so there was no cost involved. As PFMS is used by all State and Central Government agencies so it is easily replicable. ◗ DBT payment: Establishing a DBT Payment System in the pursuit of a sustainable development and economic growth is very important. ASHA Payment System develops the epayment system by transforming traditional payment process to electronic payment practices which has broken new grounds and has taken a global dimension. ◗ Motivate ASHA, develop their economic growth and improve health services: After payment to ASHA become regular, it motivates the ASHA in performing their activities regularly. It also helps in the economic growth of them and helped improvement of health of the community. ◗ Transparency: Using the new system, the payment process to ASHAs became very transparent. All the data can be viewed anytime using the web-based system. (Source: National Health Mission, Ministry of Health and Family Welfare, Government of Assam)

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I N T E R V I E W

‘PPP IS THE ONLY WAY FORWARD FOR INDIA TO DEVELOP A PAN-INDIA, INTEGRATED HEALTHCARE SYSTEM’ Dr Ajay Gupta, Group MD and CEO, Indo UK Institute of Health (IUIH) speaks on the 11 med-cities project and how it would instil the UK paradigm of effective and affordable healthcare in India, in an interaction with Prathiba Raju

How did you come up with the idea of 11 med-cities, why did IUIH chose India to develop these med-cities? My endeavour is to bring in the UK way of healthcare, one of the best integrated, affordable, world class healthcare service which can be provided to the local community. I met Prime Minister Narendra Modi in 2015 and proposed the concept of one med-city, but he was the one who suggested to go for a pan India initiative. So, 11 medcities will be built in Punjab, Gujarat, Andhra Pradesh, Rajasthan, Karnataka, Uttar Pradesh, West Bengal, Maharashtra, Madhya Pradesh, Haryana and Telangana. Also, healthcare is one of the priority areas in the

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bilateral relationship between India and the UK. My aim is to be a catalyst and provide IndoUK Institute of Health (IUIH) programme, one of the world’s largest healthcare initiatives, and ensure provision of quality healthcare and medical education services across India. What kind of difference will the 11 med-cities bring in to the Indian healthcare system, particularly the PHC, CHC and DH levels? In India, the healthcare system lacks trust, transparency and there is no accountability. As for National Health Services (NHS), UK, it is a trustworthy organisation. They believe and value in working for patients

and they focus on providing ethical and affordable healthcare to all. NHS UK will definitely transform the quality of healthcare and medical education services across India. Each med-city will be developed in partnership with a leading NHS Trust under a commercial contract. The project will enable smart digital hospital solutions and services in a big way, including remote monitoring. We have already partnered with IBM and they would be opening 5000 centres across India which will provide telemedicine. For example; before setting up a centre, a disease profile of the vicinity is done. In Nagpur (Maharashtra) we found that many suffer from haemophilia. So, the centre will

My aim is to be a catalyst and provide IUIH programme, one of the world’s largest healthcare initiatives

be inclined more towards catering to such diseases and we plan to develop a stem cell research centre. The disease profile survey is done by PricewaterhouseCoopers (PwC), our partner in this endeavour. Another unique and firstof-its-kind initiative, which is part of the IUIH project is the establishment of 5000 mobile relocatable units (MRU) pan-India, nearly 500 units will be functioning in primary and secondary catchment areas of the 11 med-cities. The MRUs, which are designed in Japan, are GPS-enabled. In Maharashtra, the 500 MRUs will serve the population from South Madhya Pradesh right till Mumbai for five years.

MRUs will provide facilities like X-rays, blood tests. The samples of the test done in MRUs are sent to Nagpur using automated artificial intelligence (AI). By June, we will have the MRUs around Nagpur operational and the Nagpur hospital will be functional by December 2019. Primary healthcare centres , operational by the Government of India, is only one for three lakh population. Instead, 10 MRUs will serve every three lakh population. Can you give us details on the med-cities? Each med-city project will be put up at a cost of ` 1000 crores, but the Amravati centre in Andhra Pradesh will be a Rs 1600 crores project, as Chief Minister of Andhra Pradesh (AP), Chandrababu Naidu wanted the IUIH headquarters in Andhra Pradesh. So, the investments will be more with additional facilities like an exclusive data centre by IBM and 10 other med-cities will be maintained from Amravati. It is a 13-years project, every year two med-cities will be constructed and the project will be completed by 2022. Initially, hospitals in the 11 med-cities will be functional with 250 beds and later it will scale upto 500 and 1000 beds. The Prime Minister's Office (PMO) has placed a task force, which is headed by Secretary, Health Ministry of Health and Family Welfare (MoH&FW). The task force has 13 bureaucrats as representatives from Ministry of Railways, Ministry of Finance, Chief Secretary of states where the med-cities are built and a representative of Niti Aayog. The task force meets every six months. Mostly, the challenges, which the projects encounter, such as land, finance etc. are tackled in the meetings. What would be the cost pattern of med-cities, are any medtech companies involved? Our aim is to make med-cities affordable, the costs in these med-cities hospitals would be below the corporate hospitals. For example, a total knee

CANDID MOMENTS

replacement in a private hospital would be charged at Rs four lakhs, but we would charge about ` 2 lakhs. We are partnering with 40 NASDAQlisted medical technology companies like Medtronics, Zimmer, Biomet, Stryker for 20 years. They will be manufacturing in our sites, for example; a CT machine will be manufactured in Nagpur, in Amravati there will be a SEZ set up to manufacture medical equipment, this will also enhance the Make in India programme. Apart from hospitals the med-city would also have college in which NHS, UK will train 5000 doctors and 25,000 nurses. Later, each med-city will have a specialised training academy in Nagpur, the Zimmer will start the first training academy for knee replacement, while in Hyderabad, Stryker will open its academy for hip replacement and Medtronics in Amravati will have a training academy for cardiac related issues. The reason for imparting one excellence in one centre is that we don't want to have competition within the medtech companies. Also, it helps each medcity to become a centre of excellence

Every year, two med-cities will be constructed. The project will be completed by 2022. Initially, hospitals in med-cities will function with 250 beds. It will be scaled to 500 and 1000 beds

in each expertise. All the 40 NASDAQ companies will contribute 0.5 per cent of there CSR funds to IUIH, which will be a total of 20 per cent, this would be reserved for BPL. What are the research programs to be launched in the IUIH centres? We are focusing on three types of research programmes, first is the transnational, research - designing new implants, medicines for Asians, by the UK universities. Second is stem cell research, which is currently not done in India, while the third is clinical research, which will start only in the third phase, when India develops its clinical research policies. What is the way forward for a robust healthcare segment in India? Public Private Partnership (PPP) is the only way forward

for India to develop a pan-India, integrated healthcare system. The new National Health Policy (NHP) talks about PPP to ensure affordable price. As for the UK government, with Brexit coming, they want to have a tie up with India, as it is a very big market for them with 1.2 billion people. With growing middle class in the country, they foresee more trade options. What is the investment made on the IUIH project? The total investment is over a billion dollars, of which approximately $300 million funds are being raised through equity. We are also in discussion with the UK Export Finance, accredited agency of UK government, which supports such projects for about approximately $600 million. prathiba.raju@expressindia.com

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RADIOLOGY I N T E R V I E W

There is an exponential growth of scientific knowledge in radiology which needs to be explored' Dr Mohanan K, Professor and HOD of Radio diagnosis, Govt Medical College, Thrissur, Kerala, has been recently elected as the 74th President of IRIA. He is the first president from Kerala and has a strong agenda for change in the Indian radiology sector. Raelene Kambli catches up with Dr Mohanan K to understand his vision for Indian radiology

We decided to launch the RAKSHA programme, a nationwide initiative to save the girl child

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Congratulations for becoming the new President of IRIA. I would like to know your vision for the upliftment of the radiology sector in India. Thank you! India, being the second largest country has an immense scope for the radiology sector to flourish. India has a large number of radiologist as compared to many countries in the world. 50 per cent of our radiologists are young and so the scope for further advancements and development increases manifold. Also, considering that 50 per cent of our country’s population is below 40 years, I feel the sector is certainly poised for growth. We are at par with any country in the world with regards to technology, competence and efficiency. If you take any country from the world map, you will see that Indian radiologists are excelling in their work. Such excellence can be applied here as well. As an association, we will work for the promotion and progress of the radiologists in India. Moreover, there is an exponential growth of scientific knowledge which still needs to be explored in this field. However, institutions and colleges cannot cope up with the growing scientific knowledge. Therefore, the association has plans introduce many education programmes, workshop and conferences to spread more knowledge. I am a teacher, so I will

always give more preference to learning and research. Tell us about the new RAKSHA campaign that you have launched. I come from Kerala where the number of females are high and we do believe in empowering our girls. And my personal agenda is to make India just like Kerala. Therefore, we decided to launch the RAKSHA programme, a nationwide initiative to save the girl child. The campaign was inaugurated by Amitabh Bachchan who has extended his support to the cause. He has promised that he would advocate for this campaign and will help us in every way to make this programme successful. The two main agenda under this programme is to pledge for not doing foetal selection and track down culprits who are doing this. We as an association have also found that a lot of foetal selection is done by nonqualified people for earning money and we will be closing working with police forces to track them down. I have taken a person responsibility on this front. What are the efforts taken by you so far to improve radiation safety? We have met the chairperson of Atomic Energy Regulatory Board (AERB) and launched the Radiation Safety Awareness programme. We have requested him to not issue license to anyone who do not follow the radiation safety mechanism. Today, anyone

can purchase a radiology equipment in India. There is no norm that one needs to be a qualified radiologist to start this service. Even an Ayurvedic doctor can purchase radiology equipment, such is the state today. We have therefore requested the chairman to not allow this at least for high-end radiology equipment such as CT, MRI, PET_CT etc. So what about the Clinical Establishments Act? We the clinical establishment act is only passed by the Centre and not the states. However, it does have such provision that only a qualified radiologist needs to purchase and start a radiology centre. What will you do to promote research in India? Well, I completely believe that India needs research focussed on Indians and not the people living abroad. We are going to raise funds for research and we will have multi-centric studies. The number of radiologist in India is less in comparison to the demand of our population. What will the association do to increase the number of radiologists? We are in talks with the government to sanction more number of PG seats for radiology and we hope that soon we will hear some good news on that front too. raelene.kambli@expressindia.com

START UP CORNER I N T E R V I E W

‘Our main USP is the quality of our services’ Dr Anagha Karkhanis, Consultant, IVF and Reproductive Surgery, Cocoon Fertility and Dr Rajalaxmi Walavalkar, Consultant, IVF and Reproductive Surgery, Cocoon Fertility, have been working towards creating a market niche for their business. They share their vision with Raelene Kambli What is the vision behind setting up Cocoon fertility centres? Dr Anagha: We were both trained in fertility in Europe and the UK, and during our training period we learnt that infertility was a common problem in the world. Moreover, there are big gaps in this field that need to be fixed. About one in every six couples suffer from infertility and yet, only one per cent of Indian couples come forward for diagnosis and treatment. In India, especially, there is an immense stigma attached with infertility and associated medical problems. Apart from lack of awareness, we noticed that there is lack of structured approach to management of infertility as compared to the West. Our vision is to bring a systematic approach to infertility management at an affordable cost. So that more and more childless families have access to such healthcare facilities. Hence, we started off with Cocoon Fertility centre to provide quality services to all. A lot of fertility clinics claim 100 per cent success but during many instances it is not true, which results in a lot of people losing faith in this treatment mode. What is the success rate that you promise? Dr Rajalaxmi: Well, we do not promise a particular success rate. Our patients are therefore counselled to understand what it entails to get fertility treatment. A lot of times people come with the hope that they would immediately get success in their first treatment

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lot higher or a lot lower than average.

our clinical decision making and procedures are done by our team of highly experienced specialists only. Our embryology lab is the heart of our Cocoon Fertility Centre. This is a state-of-theart lab equipped with ultramodern gadgets and customised air filtration system to achieve Grade A air purity (EU-GMP). With the help of the latest equipment and modern technology our embryology lab is converted into a space that is adjusted at the same temperature, humidity, cleanliness and atmosphere of the womb, so that the embryos can thrive favourably and give positive pregnancy results.

How many clinics do you presently have? Dr Anagha: The first centre was opened in Thane, Mumbai and now there are three centres including Santacruz and Dadar. We have two more centres opening soon in Pune and Western suburbs of Mumbai. We hope to expand our reach to maximum cities in India. What is your strategy to scale your business? Dr Rajalaxmi :We will focus on providing quality care to our patients and will continue to expand our service through partnerships.

Dr Anagha Karkhanis, Consultant, IVF and Reproductive Surgery, Cocoon Fertility

procedure. That is where the problem lies. Effective communication helps us to convey the right information to our patient and in managing expectations. The success depends on each person’s particular case and will be different from the person sitting next to you. Hence, to fix a particular rate for success, makes it too general and doesn’t allow for individualisation. A person’s chances for success with treatment may indeed be a

What is the investment done so far? Dr Anagha: We started with self-funding. Today, Cocoon Fertility is building on the existing infrastructure of a decades-old family establishment, one of Thane's most trusted maternity homes. Hence, the investments have been minimal. However, we have recently roped in a strategic investor, the details of which are currently confidential. There is immense competition in the fertility treatment space. What is your differentiator and the value proposition you are offering? Dr Anagha: One of our main USPs is the quality of our services. This ranges right from our consultations to the quality of our embryology laboratory. These positively contribute to our excellent

Dr Rajalaxmi Walavalkar, Consultant, IVF and Reproductive Surgery, Cocoon Fertility

pregnancy rates. We believe in listening to patients patiently and educating them about every step of their treatment. This turned out to be our USP. Most of our patients tell us that it is the first time they feel they have been heard, it is the first time they understand what the issue is and it is the first time they have been explained as to how it can be sorted. Our high success rates are attributed to our work discipline and the fact that all

There is a debate that the fertility industry is misleading women? What is your opinion on the same and how would you clear this air? Dr Rajalaxmi : The industry is often blamed with claiming success rates higher than they actually are for conducting un-indicated IVF treatments or for unclear financial implications i.e. hidden charges. See in any business there are good and bad guys. Medical treatments are as much about trust as success. When our work is ethical, when we provide the best care to our patients, when we deal with our patients with complete honesty, I don’t think we need to fear. The trick is to care for your patient like you would care for a member of your family. With this ethos you would always do the right thing. raelene.kambli@expressindia.com

LIFE I N T E R V I E W

‘It would be too early to make any comment on the efficacy of the HIV Bill’ 43-year-old, Kousalya Periasamy was the first woman in India to declare that she is HIV-positive and has been fighting it for 22 years. She is one of the founders of Positive Women Network (PWN+) which helps other women living with HIV. Periasamy highlights various issues faced by people living with HIV, in an interview with Prathiba Raju What was the inspiration behind starting Positive Women Network (PWN+)? In 1990s, the status of women living with HIV/AIDS (WLHA) was appalling. They were ostracised from their family and community as the stigma and discrimination was severe. Women were blamed for their husbands’ HIV seropositive status; however, in reality, majority of the women were naive, they acquired infection through unprotected sex with their husbands. Moreover, even medically there was not much scope to manage the illness, as the antiretroviral therapy (ART) was not available in the country, ensuing higher HIV mortality rate. At this point in time, I met three other women during a preliminary meetings of The National AIDS Control Programme (NACP) II, who had similar ordeal living with HIV. While attending the programme, we four of us realised that a forum is needed

to fight and stand for the health rights of Women Living with HIV/AIDS (WLHA) and prevent further spread of HIV infection among women in the general population. We established PWN+ in the year 1998. Initially, we were more involved with establishing support groups among women living with HIV/AIDS, predominantly in the districts of Tamil Nadu. Gradually, the network has evolved into a rights-based organisation that is actively involved in advocacy, research and building networks with like minded organisations across the country, to challenge the status quo and bring about a positive change in the lives of women and children living with HIV/AIDS (W/C LHA). In the past ten years, how has the situation of treating people living with HIV (PLHIV) changed. What are the challenges

that still exist? Within the past decade, a few states including Tamil Nadu, have shown positive changes with regard to stigma and discrimination, while majority of the states in the country where the HIV prevalence rate is low, PLHIV still suffer ill treatment both from community and healthcare professionals. Recently, I got an opportunity to converse with a few women from Kerala, who narrated the miserable situation W/CLHA are forced into, back in their home state. Within families, still there are thousands of individuals unable to disclose their HIV status, even to the closer circles, due to fear of stigma and ill treatment. WLHA still have to fight for property to which they are rightfully entitled. Except for providing antiretroviral therapy, it has been almost a regular story that WLHA are denied appropriate healthcare,

even during emergency situations, in both private and government hospitals by the healthcare professionals, in fear of HIV. Poverty and unemployment are rampant among individuals living with HIV/AIDS, pushing their households into appalling conditions, despite the welfare schemes and policies intended for PLHA. While the needs of women, children and men living with HIV are radically different from each other, the existing policies are being indifferent to such differences, bluntly address “people living with HIV,” taking the individuals living with HIV as a homogenous group. There are critical issues related to reproductive health of WLHA, not acknowledged in any of the treatment guidelines except for a pap smear test. Is access to medicines easier now than before? Are antiretroviral therapy (ART)

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February 2018

LIFE clinics pan-India dispensing doses properly or are they forcing people to either make multiple visits for drugs? It has been more than a decade, since the government of India initiated free antiretroviral treatment for PLHA. ART roll outs are spread across India, mostly located in district hospitals, medical colleges and tertiary hospitals. The Link ART centres at the community level are purposed to improve access to ARV drugs, treat opportunistic infections and encourage drug adherence among PLHA. However, as a matter of fact, many Link ART centres do not appropriately follow the guidelines provided to them, as a result, many opportunistic infections among PLHA go untreated. In few states, including Karnataka, Andhra Pradesh and Telangana the Link ART centre personnel are not properly paid, which in turn affects the intended functions of the Link ART centres, as the workers grow resentful. In some states, including Maharashtra, Karnataka, Andhra Pradesh and Telangana the drugs go out of stock on a regular basis. Therefore, PLHA are distributed drugs either once in a week or once in every 15 days, depends upon the availability of drugs. What are the advantages and disadvantages of the HIV/AIDS Bill, which was passed by the Parliament recently? Do you think the Bill has helped the HIV patients? How? The Human Immunodeficiency Virus and Acquired Immune Deficiency Syndrome (Prevention and Control) Bill, was passed in April, 2017. The Bill is momentous for the HIV community as it extensively draws upon the issues of stigma, discrimination, confidentiality and access to HIV prevention, care and treatment. Nevertheless, one of the major concerns raised by health activists and the HIV community was over Section 14 of the bill, which states, “The measures to be taken by the

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central or state governments under Section 13 shall include measures for providing, as far as possible, anti-retroviral therapy and opportunistic management to people living with HIV or AIDS.” The phrase “as for as possible” is essentially vague, which may lead to negligence and indifference on the part of healthcare providers. It simply indicates that neither the central nor the state governments are willing to take responsibility to provide appropriate treatment, support and care for PLHA. The Bill reflects deliberate efforts to safeguard the rights of PLHA, enabling them to maintain the privacy. However, till date, no concrete framework has been emerged to implement the bill. Therefore, it would be too early to make any comment on the efficacy of the Bill. Can you give us the details about the Women Resource Centre (WRC) for HIV women in places where the HIV infection rate was high? What is the status of it? Which are the states with high incidence of HIV/AIDS? Between the years 2010 and 2014, PWN+ managed two Women Resource Centres (WRCs) supported by UNDP, in Nagpur and Ajmer, respectively. The centre in Ajmer continues to serve WLHA till date. However, it is not funded by the government instead by a local trust named “Srimathi Sanchan Devi Bal Chand Lunawat.” Apart from the centre that functions in Ajmer, there is no other women resource centre in the entire country that serves exclusively for WLHA. In the year 2000, the first drop-in centre for WLHA was initiated in Chennai by National AIDS Control Organisation (NACO) and State AIDS Prevention and Control Societies (SACS), and PWN+ was closely associated with the project. During NACP III, PWN+ further advocated the model at the national level, to be implemented in other states. As a result of the effort, six new drop-in centres were initiated in Tamil Nadu,

Mizoram and Rajasthan. Nevertheless, all the drop-in centres were shut down by the year 2013, despite strong recommendations put forth by the project evaluation committee. Eventually, all the dropping centres were converted into Care and Support Centres (CSC) for PLHA, a nationwide project implemented by NACO and Alliance supported by Global Fund. Followed by the closure of women drop-in centres, PWN+ repeatedly appealed to NACO to allocate at least a small grant and a centre for care and support particularly for W/CLHA. But, our cries have reached nowhere. NACO, since 2015, has been asking the states to collect Aadhaar numbers of patients to avail antiretroviral therapy. To ease the process of availing the services, but many patients fear that compulsory submission of Aadhaar card for medicines and ART could lead to the disclosure of their identity and cause social stigma? Your comments. Apparently this new order has created a significant amount of distress among people living with HIV/AIDS, who avail free ART, especially the women. This clearly stands in contrast to the recently passed HIV/AIDS (Prevention and Control) Bill, 2017, which talks extensively on confidentially, stigma and discrimination. Many are not getting medicines because they are scared of there identity being revealed. Moreover, this order stands in the way of universal and free access to ART. Where would people, who live on the margins of society, like people who live on streets and slums and rural and tribal communities, go if we ask them for Aadhaar cards as a prerequisite to access ART? Do you think it was right to merge NACO with the health ministry, as the funds to states are now flowing through state treasuries instead of directly from NACO to the State AIDS Prevention and Control

Societies? Reasons. Earlier, when NACO was an independent organisation, PLHA were able to influence and hold the SACS accountable. Post merging, the situation is different, making people’s participation impossible. Previously, community involvement was encouraged in finding local solutions to combat HIV/AIDS, but now they all done by the ‘experts.’ There is no more shared accountability in combating HIV/AIDS, with government taking all the power. Nevertheless, as the result of continued efforts taken by civil society organisations, HIV/AIDS and health activists, in April 2017 the policy was amended that NACO would directly disperse the funds to SACS rather through state treasuries. Do you think an insurance scheme should be introduced to PLHIV. Why it is important to give insurance for PLHIV and why do you think insurance is not availed? Today, while there are insurance schemes available for pet animals and non living entities, certainly we should have an insurance scheme for PLHA. One of the primary reasons behind non-availability of an insurance scheme exclusively for PLHA is the common notion that HIV means death. Currently, PWN+, in association with Church of South India, Social Empowerment: Vision in Action (CSI SEVA) facilitates Life Insurance Schemes namely Baghya Lakshmi and Jeevan Mangal available to PLHA in and around Chennai. What is your expectation from the upcoming budget? We expect four elements to be given serious consideration and included in the budget. As a woman living with HIV, these four factors hold paramount significance to me. First, primary prevention among women in the general population need to be prioritised, second, there must be a programme exclusively for WLHA, addressing the critical issues faced by them, third,

apart from Prevention of Parent to Child Transmission (PPTCT), a dedicated programme on women reproductive health for WLHA needs to be budgeted, and finally, we need a programme that provides comprehensive treatment and care for all kinds of opportunistic infections for women, which needs to be budgeted. Working in 13 states, what kind of help does PWN extend to PLHIV and the children and adolescents? How many lives have you transformed? What is the road map for PWN? PWN+ is extended across 55 districts in 13 states of India, with each state having a chapter of positive women network with a separate board. However, due to lack of resources, at present, only eight state level networks are active, which include Tamil Nadu, Karnataka, Kerala, Delhi, Uttar Pradesh, Rajasthan, Manipur and Mizoram. Hitherto, we are able to impact the lives of more than 50,000 WLHA across the country, through our State Level Networks (SLNs) and District Level Networks (DLNs). PWN+ addresses issues around prevention, treatment, care and support, economic empowerment and rights of women and children infected and affected by HIV. Currently, PWN+ serves women and children living with HIV/AIDS through programmes, including an intervention programme for women experiencing severe side effects of ART, an income generation programme for the households of WLHA, organising primary prevention campaigns in and around Chennai, talent identification and development programme for CLHA (Story Writing and Drawing) and there are two research studies currently in progress, one is aimed to identify the holistic needs of children living with HIV/AIDS and the other is on reproductive health needs of WLHA, based on the study, appropriate interventions will be planned and realised. prathiba.raju@expressindia.com

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

In India, we aim to focus on providing high quality care Aditya Singh, MD, DaVita Care India in an interaction with Express Healthcare, talks about DaVita’s latest offering in dialysis treatment and the company’s growth prospect How do you foresee growth in the Indian dialysis market? Less than 10 per cent of End Stage Renal Disease (ESRD) patients who need dialysis are currently on dialysis treatment, which is indicative of a huge need-gap. Most of the need gap exists in Tier-II and Tier-III cities, where there is considerable potential to offer treatment and bring quality care to patients. In metros and TierI cities, where capacity for dialysis treatment is already in place, there are opportunities for qualityfocussed providers like DaVita to offer the latest in dialysis treatment and excellence in clinical outcomes. As such, there exists a potential for double digit growth in the number of dialysis patients, especially in Tier-II and Tier-III cities. Would you like to share some insights on the challenges and opportunities to improve dialysis access and care in India? There are three key challenges to overcome: 1) lack of awareness and diagnosis 2) affordability 3) infrastructure and trained manpower 1) Diagnosis and awareness: There are approximately 1,200 nephrologists in India for a population of over 1.3 billion people or approximately one nephrologist per 1,100,000

DaVita, which focusses on dialysis care, helps build operational efficiencies for healthcare providers and creates opportunities for clinical excellence

population. In comparison, the US has roughly over 10,000 nephrologists for a population of about 323 million people or approximately one nephrologist per 33,000 population. The obvious answer is that we need more nephrologists. However, that can only be a long-term goal; in the short term, there is a need to train more physicians to be able to detect and manage kidney diseases in its early stages. 2) Affordability: In most countries where dialysis treatment has evolved, there is a well-developed government and charitable support structure that subsidises dialysis as it is an expensive life-sustaining therapy. In comparison, approximately 60 per cent dialysis patients pay-out-ofpocket for their treatment in India. While the government has done a commendable job in launching the National Dialysis Programme, the programme needs to be revisited to ensure outcomes-centric results for patients and provision of adequate remuneration levels to sustainably support quality treatment. 3) Infrastructure and trained manpower: Significant investment in infrastructure and capacity is needed along with the creation of training programmes for dialysis therapists and medical officers.

How can hospitals benefit by outsourcing or bringing in speciality providers? Dialysis is a highly specialised therapy and needs considerable expertise; often it is not the core competency or focus of a hospital, but it is necessary to offer a full range of services. In this context, a speciality dialysis provider can add value in the following ways: 1) Standardised and industry-recognised clinical policies and protocols incorporating global best practices. 2) Ability to recruit and train dialysis manpower at a much larger scale as compared to any single hospital. DaVita envisions building the greatest healthcare community the world has ever seen. What opportunities does this present for healthcare providers and hospitals? Hospitals are faced with a challenging business environment and providing quality care requires meticulous efforts. DaVita, which focusses on dialysis care, helps build operational efficiencies for healthcare providers and creates opportunities for clinical excellence. DaVita is committed to providing quality care for their patients and achieving high patient satisfaction.

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DaVita is a community first and a company second. Can you please elaborate on the community-based approach of DaVita and how it gets reflected in the way patients are treated? DaVita, which is Italian for ‘giving life’, is committed to providing quality dialysis care in India. A communitybased approach forms the spirit of DaVita and we take pride in the way we care for each other, our patients and our communities. Our Core Values – Service Excellence, Integrity, Team, Continuous Improvement, Accountability, Compassion and Ananda – are our beliefs and guiding principles that enable and encourage us to make the right decisions and deliver industry-leading care to our patient community. Our ‘Zero Compromise Dialysis’ policy reflects in our holistic approach to dialysis treatment with extensive patient counselling, integrated treatment plans covering dietary management, anaemia management, vaccinations and other medication management as well as individualised improvement plans for patients. As part of giving back to the community, we offer education about Chronic Kidney Disease and ways to prevent it via education camps as well as running nocost kidney screening

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programmes. Bridge of Life (BOL) is an international non-profit organisation, founded by DaVita, working to improve health, wellness and vitality. BOL’s mission is to improve kidney care in underserved areas of the world. We partner with them to help raise funds as well as provide volunteers for their missions. What, according to you, are the global practices in DaVita which set you apart from other dialysis providers in India? We rely on three important parameters to ensure quality dialysis services: Well-designed policies and protocols ◗ Patient comfort ◗ Infrastructure ◗ Policies and protocols: We are committed to implement global best practices in healthcare including topnotch infection-control protocols. Our operations are driven by policies and protocols defined by experts in nephrology and customised to Indian conditions. We have a dedicated clinical services team focused on patient satisfaction and tracking clinical outcomes. Patient comfort: DaVita strives to improve patients' quality of life by innovating clinical care and offering integrated treatment plans. We believe in attentive and

compassionate care and have several patient comfort facilities including dialysis recliners and individual TV screens. Infrastructure: We monitor electronic patient data in real time, enabling us to take corrective measures to mitigate harms from the physiological changes that occur during dialysis. We have state-of –the-art machines with data-capture facility, bringing in expertise from DaVita USA and quality RO plants. How many new partnerships are expected in 2018? What message would you like to share with prospective hospital partners? In India, we aim to focus on improving the overall standard of dialysis care in the country. To that extent, we would like to work with like-minded and valuealigned hospital partners. We prioritise quality care over rapid expansion and, thus, have no numerical target in mind; we will open centres and work with partners based on the above objectives. We are invested in improving clinical outcomes for our patients. Any interesting update you would like to share with the readers? Kidney disease is likely to affect 1 in 10 Indians.

However, the awareness about its seriousness remains low, at only 7 per cent of the total population. Hence, it is important to detect kidney disease risk factors early on, so that adequate treatment can be provided, and progression of ESRD can be mitigated. Keeping these objectives in mind, we recently collaborated with ‘Spreading Hope’, a non-profit foundation, to start a panIndia drive on kidney awareness and organ donation. Spread across 11 cities covering 9,000 kilometres, the initiative was focussed on increasing awareness on kidney disease through classroom-type sessions and no-cost kidney screenings. Kidney disease is a silent killer and there has not been enough cognizance about it in India. This collaboration is a small step towards raising the awareness level and dispelling widespread notions about renal problems. About DaVita Care India Private Limited DaVita Care India Private Limited is a part of DaVita Inc., a Fortune 500® company, and a leading provider of kidney care in India, delivering dialysis services to patients with chronic kidney failure and end-stage renal disease. As of October 2017, DaVita Care

India Private Limited serves over 1600 dialysis patients across 25 centers in 13 cities. For more information, please visit DaVita.in. About DaVita Inc DaVita Inc., a Fortune 500® company, is the parent company of DaVita Kidney Care and DaVita Medical Group. DaVita Kidney Care is a leading provider of kidney care in the United States, delivering dialysis services to patients with chronic kidney failure and end-stage renal disease. As of September 30, 2017, DaVita Kidney Care operated or provided administrative services at 2,470 outpatient dialysis centers located in the United States serving approximately 218,200 patients. The company also operated 230 outpatient dialysis centers located in 11 countries outside the United States. DaVita Medical Group manages and operates medical groups and affiliated physician networks in California, Colorado, Florida, Nevada, New Mexico, Pennsylvania and Washington in its pursuit to deliver excellent-quality health care in a dignified and compassionate manner. DaVita Medical Group's teammates, employed clinicians and affiliated clinicians provided care for approximately 1.7 million patients. For more information, please visit DaVita.com/About.

TRADE AND TRENDS

nice Neotech Medical Systems launches new products THE QUALITY, Reliability and Versatility of OxyM Blenders are designed as per the standard to meet the ICU and NICU requirements.

feature ◗ Available in very low to high flow capability ◗ Suited to speciality and general needs ◗ Mounting solutions for all situations ◗ All blenders are equipped with an audible alarm

Dual Flow Meter The OxyM Blender with integrated flowmeters has been specifically designed for use in the NICU. The 0-15LPM flow meter on the left can be used to connect to a Resuscitator. The flow meter on the right, which can be fixed in 0-15, 0-3.5 or 0-1.0 LPM, can be used to connect an infant nasal cannula.

Bleed Turn ON/OFF The OxyM Blender’s unique features let turn the bleed required for low on and off simply by pushing in and rotating the right hand flow meter. It saves time and reduce frustration, because there are no parts to disconnect and misplace, And the OxyM B is always ready to use.

nice 5010 High/Low Flow Blender

Nice 5010 Cascade Flow Meter

Versatile dual range blender. Ideal for equipment needing flows from 2-120 Ipm, yet also capable of increased accuracy even at a low flow range.

nice 5005 Low Flow Blender Perfect for NICU and newborn nursery or for a flow of 30 Ipm or less. Increased accuracy at even the lowest flow range.

Blender with resuscitator

Nice 5005 Cascade Flow Meter

Applications OxyM Medical Air/O2 blenders combine compressed Medical Air and Oxygen to deliver blended pressurised gas at a precise oxygen concentration (FiO2) firm bye the user. Some models are equipped with a unique gas bleed ON/OFF switch to increase accuracy when needed, conserve gas, save money and time. These blenders are suitable for respiratory applications including routine therapy, ventilator gas supply, Bubble CPAP, SiPAP, Resuscitator and critically -limited NICU procedures. nice Neotech offer different models with multiple outlet ports that deliver the same highly accurate selected FiO2. Most models can be customised to include the flowmeter attachment with a variety of flow rates available. The blenders contains an audible alarm which warns the user if either of the gas sources changes by more than 30PSI from the other. Medical air and oxygen blenders require a bleed for accuracy. The bleed on a blender is activated by the knob which is placed on the right port. This avoids the blended gas being into the air when the blender is not in use.

Unique features ◗ nice 5005 and nice 5010 have gas savings ON/OFF bleed

◗ To provide continuous supply of air and oxygen blenders gas for Bubble CPAP and T-Piece Resuscitator.

OxyPAP Nice 5060 Bubble CPA

Provides essential equipment for safe and easy delivery of neonatal CPAP ◗ Optimise lung protection and breathing support Continuous Positive Airway Pressure (CPAP) supports infant breathing by providing respiratory support throughout the respiratory cycle. OxyPAP maintains the infant’s functional residual capacity by helping to prevent airway closure. CPAP promotes gas exchange in the alveoli, which acts to enhance airway patency, improve lung volume recruitment and maintain infant energy reserves, without the complications associated with endotracheal intubation. Optimal humidity (37°c, 44mg/L) with CPAP is vital to support an infant’s breathing and protect and protect its developing lungs. Optimal humidity protects the lungs to optimise outcomes for the infant by minimising airway drying, improving secretion clearance, reduce airway constriction.

Features ◗ Safe and reliable The Unique Bubble CPAP generators provides consistent and accurate delivery of CPAP. The reusable pressure manifold with pressure relief valve for infant safety The manometer is provided to ensure the delivery of accurate PEEP. Rotating

PEEP adjustment Knob to prevent the use error of setting the PEEP. Servo control humidifier with temperature indication with heater wire for humidity of delivered gas. ◗ Easy to use Easy to adjust the PEEP setting on the Bubble CPAP generator. Easy to set modes of humidifier Easy to fix the nasal prong with the neonates. ◗ Optimum humidification The Bubble CPAP system provides respiratory supports with body temperature, pressure saturated gas to the infant. Optimal humidity promotes mucociliary clearance and reduces the work of breathing. ◗ Infant nasal prongs Contoured nasal prongs made from non-reactive silicone along with a unique cannula body provides stability during therapy. The integrated pressure monitoring line allows the monitoring of nasal prong pressure without having lines near the infant's face Offered in seven different sizes, it can be used on a wide

range of patients from premature to new born baby. ◗ Bubble generator Bubble generator provides a convenient means to apply positive airway pressure, freeing the clinician to focus on patient care, not the device. This design delivers accuracy and stability throughout the course of therapy. The ergonomic design allows airways pressure to be easily set without the cumbersome time consuming tasks normally associated with bubble devices. Water feeding port allows water to be added or removed by disconnecting the expiratory circuit. Minimum and maximum lines clearly visible in highly transparent jar with overflow container. Contact details nice Neotech Medical Systems No 85, Krishna Industrial Estate, Mettukuppam, Vannagaram, Chennai - 600095. Tamil Nadu Tel: + 91 44 2476 2594, 2476 4608 Web: www.niceneotech.com

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Carestream Health unveils new medical imaging, healthcare ITproducts at India’s largest radiology conference Carestream invited attendees to explore and advance radiology, through innovative means which create a positive impact on patient care CARESTREAM HEALTH demonstrated its expanding portfolio of medical imaging and healthcare IT systems at the 71st annual conference of the Indian Radiology & Imaging Association which was recently held in Mumbai. This year the IRIA was combined with the 17th Asian Oceanian Congress of Radiology, making this a not-to-miss event in the annals of radiology conferences in India.

quiring, collaborating and sharing, medical images. The acquire interactive wall showcased the following products, highlighting the key benefits of each while displaying the workflow; The DRX-Evolution Plus, is a fully automated, ceiling suspended digital X-ray system with greater flexibility, extended tube column and a high performance Carestream generator. The forward looking de-

CSH_DRXRevolution8

With the theme explore, invent, transform, Carestream invited attendees to explore and advance radiology, through innovative means which create a positive impact on patient care. The company displayed an interactive touch wall which offered a first-of-its-kind, unique experience of Medical Imaging workflow. The fascia was once again futuristic and revolutionary in the true sense, especially in world of Indian radiology. The interactive touch wall exhibited the company’s innovative imaging solutions for ac-

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advanced enclosure design provides total protection against intrusion, dust and water. The Vita Flex CR System: The reason for the Vita Flex CR ‘s popularity includes its compact size, user-friendly nature, option for the radiologist to carry out simple repairs onsite, and a mini-PACS option to view images on the go. On the collaborate section Carestream displayed its Vue

On the interactive Output touch wall, the display included; Carestream’s Managed Print Solutions (MPS) which has brought about a revolution in the system of ordering, purchasing and stocking of X-ray films. The system, which operates through a dedicated webportal designed by Carestream’s team of specialists, has made the entire process completely automatic.

drxevolution plus

sign of the DRX Evolution Plus is devised to accommodate advanced imaging applications in the future. DRX-Revolution is Carestream’s mobile X-ray system with a fully automatic collapsible column. Powered by a wireless DRX detector, this X-ray room on wheels drives like a dream and providing fast and high-quality images. The DRX Plus Detector: The DRX Plus detectors are lighter in weight, faster and more reliable than the earlier versions of the DRX family. Its Ingress protection rating and

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

The Carestream MyVue Center Self-Service Kiosk is the future of patient enabled imaging. This self-service radiology kiosk improves patient experiences by allowing them to print, store or share radiology images and reports while maintaining their privacy. It also helps busy radiology departments overcome challenges in meeting the expectations of growing patient populations amid reductions in operating budgets and staff thus improving workflow productivity while reducing capital and operational costs.

The DRYVIEW 6950 Laser imagers’ extremely sharp 650 ppi resolution on every film size, provides exceptional image quality for general radiography and mammography. The highlight of the exhibit was Carestream’s award winning OnSight 3D Extremity System which produces detailed three-dimensional cross sectional images of injuries to bone or soft tissue in upper and lower extremities. It performs both 2D and 3D extremity exams which includes weight-bearing studies, thus enabling physicians to view these body parts under natural load. A huge advantage to the patient is reduced radiation exposure which is 50 per cent lower than that of standard full-body CT. “From design features that ensure patient comfort and convenience, to technologies that allow patients to view and manage their diagnostic images, and X-ray systems that enable rapid diagnosis and timely treatment, our advanced solutions support our customers in delivering true Patient-Centered Care. This focus has enabled us to develop products like the MyVue Centre Self Service Kiosk, Onsight 3D Extremity System, Vue Clinical Collaboration platform and several other products. In 2018, we will continue to deliver on our promise of helping customers do their jobs better, faster and more cost- effectively,” said Sushant Kinra, MD, Carestream India. Products displayed though this interactive touch wall, coupled with new products on the floor highlighted the company’s focus on creating inventive and elegant solutions that offer customers a smarter way forward. Contact details www.carestream.in

TRADE AND TRENDS

Healthcare sector evolution: Innovations and initiatives Vivek Tiwari, Founder and CEO, Medikabazaar, gives an insight on how technology can play an exceptional role in increasing healthcare access and decrease cost burden HEALTHCARE IS going to rapidly evolve in India with overall healthcare sector is expected to touch the revenue of $280 Billion by 2020. The sector is poised to become the largest employment oriented sector in the economy with workforce in this sector expected to be at 7.4 million by 2022. It is a high time that government should realise this neglected sector as a greater economic development activity at national level. The healthcare is traditionally seen as social sector with lesser government focus with low percentage of GDP spend on healthcare. In the last decade or so, the consumer spend has shifted from curative to preventive healthcare with greater awareness on health and fitness and with more diagnostic labs and preventive check up clinics coming up in the country. With rising incidence of chronic and non-communicable diseases burden in India, the healthcare spend is likely to go very high in the near future as well. Our country still is majorly not represented by health coverage especially in tier II and tier III cities and even with the efforts taken by the government lately; the poorly penetrated health

coverage is going to be a greater challenge for healthcare affordability. As per industry experts, the answer to decreasing the burgeoning healthcare cost burden lies in bringing systematic efficiency in the healthcare sector with focus on cost management, efficiency and operational excellence. The basic challenge equation is time and cost management leading to efficiency in output. There are traditionally three cost challenges healthcare institutions must start looking at; cost reduction, cost elimination and cost avoidance. The key factors for healthcare sector growth and sustainable efficiency will be adoption of technology and setting up a seamless patient data management record. The advent of mobile technology and e-commerce growth in India, the healthcare sector is also witnessing growing interest of entrepreneurs willing to take up the challenge in building up innovative and cost effective digital platforms for patient data record management, telemedicine, medical appointment tool, diagnostic or medical test enrolment and hospital supplies / procurement platforms. The basic challenge

The key factors for healthcare sector growth and sustainable efficiency will be adoption of technology and setting up a seamless patient data management record

still lies with adapting of these technological platforms in tier II and III cities and rural areas with biggest challenge of costing. Also with rising focus on technology adoption in healthcare; the demographic shift will fuel the growth of this sector. The way technology had changed the consumer landscape of banking and telecommunications industry, it is yet to create such disruption in healthcare sector. India still needs to witness the likes of telecommunication and BFSI revolution in healthcare. Today more than half of the population do not have access to primary healthcare in the country and with technology, this can be provided at half of the cost of traditional solution. The core idea is to have healthcare access should be without an excessive burden on the masses. The main aim is to create an access with an adequate level of affordability with special attention to the vulnerable groups such as children, women, disabled and the aged. Some of the provisions made during Union budget 2016-17 by the government of India for promotion of Indian healthcare industry have been well accepted. National dialysis service programme to be initiated

in all the district hospitals to accommodate the increasing demand of dialysis sessions has been well accepted in the dialysis fraternity. Under the national health assurance mission, government will provide citizens with free drugs and diagnostic treatments as well as insurance cover to treat serious ailments. The E-health initiative, which is a part of Digital India drive launched by the Indian government, aims at providing effective and economical healthcare services to all. The E-health initiative programme aims to make use of technology and portals to facilitate people maintain health records and book online appointments with various departments of different hospitals using eKYC data of Aadhaar number. In the nutshell, technology has an exceptional role in increasing healthcare access and decreasing cost burden on healthcare. The government has to take more initiatives to boost this sector with inclusion of both private and public sector. Contact details Boston Ivy Healthcare Solutions Mumbai www.medikabazaar.com

One Day we will beat Cancer Help us make it sooner Support, Volunteer and Donate at www.springhopefoundation.com Follow us on youtube.com/channel/UCy4yXkBUhdzyNHO_t8cR1Ig facebook.com/SpringhopeFoundation twitter.com/springhopeCF

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TRADE AND TRENDS

DiaSys India completes three years of service WITH GREAT pleasure, DiaSys India announces the completion of three successful years. During this short journey, the company has made memorable and notable accomplishments in the backdrop of very challenging economic environment in our country. Shifting manufacturing unit to spacious, state-of-theart Mahape premises in March 2017 shows the commitment for providing high quality indigenous products. DiaSys India has launched many exciting products during these three glorious years and improved services in a bid to strive for perfection in every domain. It registered close to 20 per cent annual sales growth over last year. The company employs 180+ employees in different functions located at various geographical locations. The company said, “Thanks to all our distributors who stood with us at all times, gave us constructive feedback and remained committed to our aggressive growth plans.”

Road map ahead Increased awareness amongst

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

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DiaSys India has launched many exciting products during these three glorious years and improved services in a bid to strive for perfection in every domain. It registered close to 20 per cent annual sales growth over last year.The company employs 180+ employees in different functions located at various geographical locations people, high percentage of affordable population, reimbursements by insurance companies, exponential jump in life style related ailments has made IVD industry rise rapidly. The company has listed key enablers for meeting ambitious, comprehensive agenda for strengthening our position in Indian market: ◗ DiaSys India now takes this opportunity to announce launch of its newest and most exciting systems in DiaSys India product portfolio – 3 part (respons r3H) and 5 part (respons r5H) differential haematology analyser. With this launch, the company has announced its foray in haematol-

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,

ogy segment. ◗ Innovative technological advancements are rapidly changing healthcare landscape. DiaSys India proudly boast existence of research and development centre in India. ◗ DiaSys India RnD is fostering innovation and is set to launch in-house developed product range starting with Electrolyte analyser by third quarter of this year. ◗ The art of diagnostics is infinitely creative and it inspires us to continuously improve quality of the products. Through regular investments and employing skilled manpower, DiaSys India seeks to accelerate the introduction of

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.

processes, technologies, and regulations required to continuously roll out high quality products from its manufacturing unit located in Mahape. ◗ This is also helping DiaSys India build sustainability into its products and operations. The company is adding 45 new employees in DiaSys family for strengthening all our company functions. ◗ DiaSys India Urine portfolio, Rapids, POC are set for higher growths this year through focussed approach and dedicated resources for doctor clinics in tier II and tier III cities. This will help doctors offer right and quality treatment to needy patients on time. ◗ DiaSys India completely

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understands the dynamic nature of systems in labs. Customer needs systems to be functional round the clock to meet normal and emergency workload of patients. The company has decided to improve after sales service as satisfied customers will help it in brand building and profit generation. A lot of emphasis is being given to recruitment and technical training of engineers this year. With our expertise and experience, we are clear on: ◗ Arenas ◆ Where will we be active geographically and product wise? ◆ Who will be our core customers and what it takes for us to retain them? ◗ Differentiators: ◆ What different will we do from our competitors? ◆ How will we win? In short, with right blend of products and aggressive people, DiaSys India has embarked on an exciting journey with passionate commitment for profitable growth and giving paramount importance to customer satisfaction and patients’ welfare in India.

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

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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