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2015, a year of Rapid Transformation and Adaptation in Healthcare

With the emergence of new government in May 2104, country has witnessed a lot of transformation either through the mode of, making India digital or make in India. Among many sectors which have gone through major changes in last year healthcare is one of them, where lots of new initiatives and new measures has been taken.

It has been a year in which health care made regular news, whether for steadfast Republican opposition to the Affordable Care Act, high drug prices, continued consolidation of health care providers or an array of new reforms ushered in by modi government, that have gradually but fundamentally altered the health care marketplace.

To strengthen the healthcare system for provision of accessible and affordable healthcare to all those who access public health facilities, Central government under National Health Mission supports majorly to the state government.Adaptation-in-Healthcare

Population health, a push to keep people healthy and out of the hospital, gained traction in multiple settings across the country, including accountable care organizations, bundled-care plans and clinically integrated health-care networks. These networks link patients to the full spectrum of services, from preventive care to highly specialized hospital care. The goal is to help keep people healthy and intervene before costly care is necessary.

Wearable medical devices, cloud-based computing and transparency initiatives enable consumers to make more informed health care choices. Consumers also have more choice; they can purchase coverage privately, through their employers or through state and federal insurance marketplaces. Employers, in some cases, have established their own marketplaces. Those shopping for insurance can choose between comprehensive or high-deductible plans.

In order to look, what government has achieved so far and how their efforts have been perceived by the healthcare fraternities around the country, here are the insights from various health care professional from the entire domain:

Amol Naikawadi, JMD Indus Health Plus says, “The year 2015 began with a focus on prevention and with a renewed interest from the government who were aligning their plans  to step up healthcare sector. Initiatives like Health for All and The National Health Assurance Mission is a sheer reflection of why do we need to re-emphasize on improving preventive healthcare facilities. We forsee a significant scope for government to further invest in preventive healthcare to reduce the burden of Non Communicable Diseases in the country.  India currently spends 1% of GDP on public health which should be increased further in catering healthcare needs. In 2016 we expect the current tax exemption bracket to be revised keeping in mind factors like premium paid towards health insurance.”

Arvind Kumar, Founder, Attune Technologies.”Information technology is rapidly becoming an integral part of the healthcare industry. Advanced mobile (mHealth) and electronic (eHealth) solutions reach out to the entire population and serve the needs of the complete healthcare ecosystem in the most effective manner. With the emergence of new data collection systems, analysis methods, and actionable intelligence, it becomes possible to view the bigger picture and identify the root cause of the problem, leading to a more proactive preventive approach to medicine as opposed to just curing the ailment. The availability of real time patient information in a centralized secure platform presents opportunities for performing phenomenal analytics with meaningful business intelligence gathering frameworks such as disease burden, health budget effectiveness, epidemic information, real-time outbreak monitoring, and interventional strategies. Moreover, with the dawn of affordable human genome sequencing coupled with Cloud-based big data analytics as well as the increasing popularity of wearable devices for monitoring the healthcare of individuals, we are nearing the era of personalized medicine”.

Hisao Masuda, Managing Director, Omron Health Care, India. Telemedicine and digital health clinics: Telehealth is combination of health related services with digital information and communication technologies, such as computers and mobile devices, to manage health and well-being. Telehealth is often referred to diagnosis & monitoring that is delivered by technology, health management & other medical / health services, self management of a patient health while patient is at medical centre or at a distanced location.  The patient can effectively monitor their health by connecting the monitoring device with the health app, and basis the monitored readings the app will suggest measures like a health tips or reading variation. It will also indicate or remind when does the patient need to visit the doctor, depending on the health readings. Preventive healthcare & Home monitoring will pick up pace with tele health.

Tier II cities fast adopting a preventive lifestyle:

The lack of adequate medical facilities across the cities is propelling the adoption of home monitoring devices. Tier II and III cities are witnessing over 20% growth as compared to only 15% in key metros. Factors like rising adoption of technology, expansion of hospitals and specialized clinics and increasing awareness about preventive healthcare is aiding the growth of the medical devices segment. These cities represent an area of under-served need, with a growing need for improved health infrastructure.

Rise in the online purchase of preventive medical devices:

With the marketplace going online, consumers have access to millions of products and services. And as preventive healthcare catches up with the consumers across the country, there is a rise in the purchase of preventive medical devices online including blood pressure monitor, step counter, digital weighing machine etc. This change in consumption pattern will continue to gain momentum in 2016.

Puneet Aggarwal, CEO, Nirogam India Private Ltd.:”Since the Narendra Modi government got elected in 2014, it is encouraging to see that the government has taken several initiatives on preventive healthcare through the ‘Swachh Bharat Mission’ and ‘Project Indradhanush’ and has increased budget allocation of Rs.5000 Cr. for the Ayurveda sector. While the Government has succeeded in propaganda, real ground action still needs more thrust on implementing immunisation drives.

Ayurveda is an indigenous science, its India’s gift to the world. We should have more ‘All Ayurvedic Primary Health Care Centres’ in villages where mother nature is in abundance. We should start tree-planting initiatives of precious herbs like Amla, Coriander, Fenugreek, Holy Basil, and the government should take the initiative to distribute free saplings of these plants in villages. It can be named as ‘Ghar Ghar Upchar’ (Every home has a remedy).

The National Health Mission should also look at setting up purification and distillation hubs in every village where Gomutra (Cow Urine) can be distilled and given as a primary aid for patients as it has been proven that Cow Urine helps in treating a lot of ailments (Reference: Indian Express – CSIR Team Testing Cow Urine for Medical Benefits).”

Mr. Rajeev M Rane – Co Founder and COO of PlanMyMedicalTrip : When the current government was given the mandate back in 2014, health care was looked at as a sector that was not given enough attention to. The elected govt. (based on the manifesto) is well aware of the most critical problems faced by the country related to health and its impact on the economic indicators.
With respect to health care in India, we appreciate the efforts put by the government in spreading awareness about hygiene by various advertisements and campaigns in rural areas.

PlanMyMedicalTrip, has well received the expected encouragement from the government with regards to the Medical Tourism industry which shows true potential in terms of GDP via Tourism and Health Care. India is already well known as the “Pharmacy of the World” and the govt. has capitalized well with its highly focused approach that can be gauged by the arrival of foreign tourists in India for medical treatment. India, especially Gujarat is now known world over as the surrogacy capital of the world and Dr. Nayana Patel of Anand is the leading specialist.

Key areas where the govt. should focus on now include subsidizing generic drugs, improving the facilities at public health care centers and most importantly, being able to provide produce enough doctors to serve the entire country.

Dr Adarsh Somashekar,  Director and Consultant Pediatrician Ovum Hospital:

  1. With the emergence of the new government in 2014, what changes have healthcare fraternities witnessed?

Well up to 2010 the healthcare industry was considerably a neglected sector in terms of receiving or allocation of funds. Since 2014 there has been visible improvement in investor sentiments in the healthcare industry. The past year also witnessed coming of age of tech enabled services. The emergence of the new government has created favorable environment for technology based solutions such as apps and mobile technologies that connect the doctor to patients to thrive. Healthcare apps such as Practo have received much recognition and appreciation. Government initiatives encouraging technological innovations and entrepreneurs saw technology
enabled services extending the reach of healthcare services.

2. How far do you think the government has succeed in their promises?

Major difference was evident in two basic fields i.e. sanitation and
hygiene. The Swachh Bharath initiative has brough visible changes in waste management. Educational and health institutes in urban and rural areas are focusing on providing better sanitation facilities. The issues of lack of toilets in rural areas was taken up seriously and awareness was spread about the importance of sanitation. In terms of NRHM(National Rural Health Mission), the healthcare services are getting the much needed push to provide better nursing and medical facilities in healthcare centers in tier 1 and tier 2 cities. NRHM has also invested in improving medical technologies such as incubators, maternity wards and expanding nursing staff to cater to the needs of mothers and newborns. This has considerable reduced
the infant mortality rate in the recent past.

3. What more policies they need from the government for the betterment of healthcare in the country?

The government must focus on developing Hi-tech healthcare centers that has state of the art medical equipments and instruments as well as skilled doctors and nurses. The need of the hour is to encourage skill development of nurses and doctors. The key area of focus must be investment in manpower. The government should initiate policies that facilitates economically viable public-private relationships. Government hospitals accounts for 30% of healthcare needs of the country at the moment, if the government encourages integration with the private sector government hospitals will be able to benefit from the skilled expertise of doctors from private hospitals. Though there has been a push in this directions, much more can be done to explore the full potential. Encouraging this public-private partnership will go a long way in improving healthcare in the country.

Dr Kaushik Murali, President Medical Administration, Quality & Education, Sankara Eye Foundation India

1. With the emergence of the new government in 2014, what changes have healthcare fraternities witnessed?

* There was a positiveness among a large part of the fraternity with
the new government.
* Health is a state subject and all national health programmes are
driven through the states.We saw states being more involved in the planning of programmes and there was a devolution of powers and finances to the states for them to utilise the same for their priorities.
* The various campaigns of Swachh Bharath and Skill India have seen an impact of public health by working on better sanitation, and enhancing the skill set of workforce. The implementation of these programmes have not been uniform across country.
* There was a focus on preventive health and a clear focus on
improving health indicators – through better immunisation, focus on maternal and child health etc.
* The makeinindia campaign has seen a fillip to R&D in India among both MNC and Indian Startups, evidenced by the large patents that are being filed from India and the large health technology and delivery start ups in our country.

2. How far do you think the government has succeed in their promises?

* With the new government in place , the manifesto showed a marked lean towards preventive healthcare and also a health assurance plan, there was a plan to make health a fundamental right, a grand concept if the same could have been implemented. However the realism of lack of funds which were prioritised probably towards economic growth did not see adequate support to these programmes.
* Also the need to depend on state governments for the delivery has a disadvantage of the plans being interpreted differently by various states and districts.( this has been especially true of the National Programme for Control of Blindness).
* We did not see an adequate budgetary allocation last year for
health. Without funds there was little possibility of all plans being put to action.
* Some of the programmes like digital India and skill India would have long term implications on health, quantifying a success/ failure in this short period would be unfair.

3. What more policies they need from the government for the betterment of healthcare in the country?

* National Programme for Control of Blindness is the most successful
public private healthcare programme second to probably the Pulse Polio (polio eradication) programme. The programme has its largest contribution from the NGO sector in terms of the surgeries performed, a confused focus of redeveloping the public infrastructure and not allowing the NGO sector to function efficiently (mostly at the interpretation of the district administration) has seen many people requiring eye care being delayed of the same. The current costs of delivery by the NGO sector would be difficult for
the public infrastructure to duplicate and would be a strain on the already meagre resources. It would be important for the Government to back this programme to hilt and prioritisation to this most successful public private partnership programme.

* The establishment of the National Institute of Allied Health
Sciences as a nodal centre with regional affiliates to enhance allied health personnel is a step in the right direction. However for scalability , the government could affiliate existing training programmes in large institutions and recognise these programmes to be equivalent to those run by various paramedical nursing boards. This would allow the development of skilled, qualified and employable healthcare resources with scant load on the government funding.
* There is a lack of clarity of what the impact of GST on healthcare
equipment would be. There is a likely increase on the costs of these
equipment which would then be passed on to patients. A possibility of exempting these or at least applying a reduced tax tariff could help ensure that beyond inflationary pressures the costs do not increase in the coming year.
* Integration of Digitisation of Health data and further governance of
the implementation of schemes through the states would help ensure transparency and efficiency of programmes.
* The cut in health budget was to be offset with increased share of
central taxes to the states. This however depends on the states prioritising health. It would be prudent for the Centre to have better control of core programmes through a budget allocation and by monitoring the same.
* More focus on safety of health personnel and also help positive
coverage of the work of the health-force would help. We hear only about the infections and deaths in media, the millions who are treated or undergo lifesaving-sightsaving procedures are not brought to the fore , probably because they are not glamorous.

Box Item,

Some of the special measures taken under National Health Mission (NHM) for the expansion of health services after May, 2014 are given below:-

New initiatives for expansion of health services

1)      Launch of India Newborn Action Plan (INAP): INAP was launched in September 2014,  for accelerating the reduction of preventable newborn deaths and stillbirths in the country – with the goal of attaining ‘Single Digit Neo-natal Mortality Rate (NMR) by 2030’ and ‘Single Digit Still Birth Rate (SBR) by 2030’. Currently, there are estimated 7.47 lakh neonatal deaths annually.The neo-natal deaths are expected to reduce to below 2.28 lakh annually by 2030, once the goal is achieved.

2)      Intensified Diarrhoea Control Fortnight was observed in July- August 2014 and 2015 focusing on ORS and Zinc distribution for management of diarrhoea and improved feeding practices.

3)      Integrated Action Plan for Pneumonia and Diarrhoea (IAPPD) launched in four states with highest infant mortality (UP, MP, Bihar and Rajasthan).

4)      National Deworming day was observed in eleven States/UTs, namely- Assam, Bihar, Chhattisgarh, Dadra & Nagar Haveli, Haryana, Karnataka, Maharashtra, Madhya Pradesh, Rajasthan, Tamil Nadu and Tripura.

5)      Launch of Mission Indradhanush: Mission Indradhanush was launched in December 2014 to reach 90 Lakh unimmunized/partially immunized children by 2020. It has been implemented in 201 districts in 1stPhase, 297 additional Districts are to be covered in 2nd Phase.  About 20 lakh children received full immunization during the Phase-1 of Mission Indradhanush.

6)      New vaccines: launch of new vaccines has been announced of which Inactivated Polio Vaccine (IPV) has already been launched on 30th November, 2015 and Rotavirus vaccine is planned to be launched on first quarter of 2016. In addition, NVBDCP has recently identified 21 adult JE vaccination districts in Assam, Uttar Pradesh and West Bengal. Adult JE vaccination campaign has been completed in three districts of Assam, selected blocks of three districts of West Bengal and ongoing in selected blocks of six districts of Uttar Pradesh.

7)      Launch of Nationwide Anti-TB drug resistance survey: Drug resistant survey for 13 TB drugs was launched to provide a better estimate on the burden of Multi-Drug Resistant Tuberculosis in the community. This is the biggest ever survey in the world with a sample size of 5214 patients. Results are expected by 2016.

8)      Kala Azar Elimination Plan : Kala-Azar elimination Plan was rolled out to reduce the annual incidence of Kala-Azar to less than one per 10,000 population at block PHC level by the end of 2015,  which inter-alia includes,

  • New thrust areas launched for UP, Bihar, West Bengal and Jharkhand.
  • New Action Plan to include active search, new drug regimen, coordinated Indoor Residual Spray (IRS) etc.
  • New non-invasive Diagnostic kit launched.

9)       Kayakalp –Award to Public Health facilities has been launched on 15th May 2015, as a national initiative to promote cleanliness, hygiene and infection control practices in public health facilities. Under this initiative public healthcare facilities shall be appraised and such public healthcare facilities that show exemplary performance meeting standards of protocols of cleanliness, hygiene and infection control will receive awards and commendation.

10)  Operational Guidelines have been  issued under NHM on :

(i)                 NHM Free Drugs Service Initiative

(ii)               NHM Free Diagnostic Services Initiative

(iii)             Mobile Medical Units

(iv)             Swachhta Guidelines for public Health Facilities

11)  New Guidelines:  The following new guidelines to strengthen capacities of States to effectively treat women in rural and urban areas of the country have been prepared:

(i)                 National  Guidelines for deworming in pregnancy

(ii)               Engaging General Surgeons for performing C-Sections and Managing Obstetric complications

(iii)             Maternal Near Miss Review Operational Guidelines

(iv)             National Guidelines for Diagnosis and Management of Gestational Diabetes

(v)               National Guidelines  for calcium supplementation during pregnancy and lactation

(vi)             National Guidelines for screening of hypothyroidism during pregnancy

(vii)           Screening for Syphilis during pregnancy

(viii)         DAKSHATA – A strategic initiative to strengthen quality of  intra and immediate postpartum care empowering providers for improved MNH care during institutional deliveries

(ix)             Daksh Skills Lab for RMNCH+A services (training manual for facilitators)

(x)               Daksh Skills Lab for RMNCH+A services (training manual for participants)





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