Digital India Archives - InnoHEALTH magazine

Digital India Healthy India

InnoHEALTH Magazine — Fri, 27 Apr 2018 06:34:46 +0000

New India, Digital India, Make India, Innovate India in making a ‘Healthy’ India

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India is a country of diversity with 1.3 billion population of which 70 per cent resides in villages and have access to 30 per cent of medical assets of the country. Poverty is a significant issue of the country, despite having one of the fastest-growing economies in the world, clocked at an economic growth of 7.6 per cent in 2015. It is estimated that 23.6 per cent of Indian population, or about 276 million people, live below $1.25 per day.

As Health is a state subject-there is lot of mismatch in states like Kerala and Punjab have best health indicators, while Uttar Pradesh is the poorest as per the NITI Aayog report. Indian government spends approx. 1.5 per cent of its GDP on health sector and mplans to make it 2.5 per cent which is much less than many developing countries while the USA has dedicated 16 per cent of its GDP. India is riddled with very basic public health issues leading to disease burden. Keeping this in mind, Prime Minister Narendra Modi has launched six initiatives: Open Defecation free country by 2019, Swachh Bharat Mission, National Health Policy 2017, Digital India with e-health, medical device manufacturing and door-to-door screening of chronic diseases.

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The healthcare needs holistic approach which depends on multiple factors. The present government has taken many positive steps including launching of National Health Policy 2017 after the gap of 12 years. It has announced many initiatives like health insurance of people who cannot afford basic healthcare and upgrading of health infrastructure.

The regulation of medical devices have been brought out and is applicable w.e.f January 1, 2018 ending uncertainty of medical device manufacturers having global market of 220 billion US dollar. Challenges bring opportunities such as Indian healthcare market is around US$ 100 billion while it is expected to grow US$ 280 billion by 2020. The healthcare IT market is US$ one billion and is expected to grow 1.5 times by 2020. There is requirement of 7 lakh hospital beds which need investment opportunities of 25-30 billion US dollar. We need to bring innovations in hospital planning,devices, diagnostics, drugs and use of technology to reduce healthcare delivery cost and yet quality.

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We failed targets of Health for All by 2000, National Rural Health Mission, and Millennium Development Goals and now launched Universal Health Coverage; its success would depend on providing healthcare facilities and strict accountability. We need to focus on primary health care and customise our healthcare delivery system by learning from experiences of other countries.

The concept of Diagnosis Related Group (DRG) making financial package for group of diseases which is known to patients, providers and third party payors should be considered by improving deficiency found in its execution by the USA.

The various schemes of present government are appreciable but success would depend on strict monitoring, corporate hospitals have high cost and many unethical practices are reported every day in media. Public hospitals to National Rural Health Mission have not delivered as required because of corruption, lack of resources and application of management practices. The need is not old wine in new bottle but strict control in implementation of various schemes launched.

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Read all the issues of InnoHEALTH magazine:
InnoHEALTH Volume 1 Issue 1 (July to September 2016) – https://goo.gl/iWAwN2
InnoHEALTH Volume 1 Issue 2 (October to December 2016) – https://goo.gl/4GGMJz
InnoHEALTH Volume 2 Issue 1 (January to March 2017) – https://goo.gl/DEyKnw
InnoHEALTH Volume 2 Issue 2 (April to June 2017) – https://goo.gl/Nv3eev
InnoHEALTH Volume 2 Issue 3 (July to September 2017) – https://goo.gl/MCVjd6
InnoHEALTH Volume 2 Issue 4 (October to December 2017) – http://amzn.to/2B2UMLw
InnoHEALTH Volume 3 Issue 1 (January to March 2018) – https://goo.gl/fksdQx
InnoHEALTH Volume 3 Issue 2 (April to June 2018) – https://goo.gl/grbtRo

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The post Digital India Healthy India appeared first on InnoHEALTH magazine.

TECHNOLOGY TO THE RESCUE

InnoHEALTH Magazine — Fri, 15 Dec 2017 06:43:37 +0000

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Dr. Sanjiv Kumar is MBBS and MD from AIIMS, New Delhi, DNB in MCH and MBA in Strategic Management. He has 41 years of experience in public health across 29 countries. He started as Medical Officer in Indian Army. He taught Preventive and Social Medicine at University College of Medical Sciences, New Delhi. He then joined UNICEF and worked for 22 years at various levels in 29 countries. He worked as Executive Director at National Health Systems Resource Centre, New Delhi. Dr Sanjiv Kumar is back to teaching as Director, International Institute of Health Management and Research in New Delhi.

Dr. Nishikant Bele received his Doctorate in Computer Science from Utkal University, Bhubaneswar, Orissa and MCA from Amravati University Amravati, Maharashtra. Dr. Nishikant has over 16+ years of experience in teaching, training, administration and research with prominent organizations. He is a SAP certified ERP Solution consultant. He had published research papers in various journals of international repute and has attended and presented papers in many international and national conferences. His areas of interest are: Health Informatics, Business Analytics, ERP, Data Modeling & Database Designing, Web and Text Mining.

India has made substantial progress in health. This is also reflected in some of the millennium development goal MDG targets that have been achieved and for others substantial progress has been made. Under-five mortality rate has declined from 126 (1990) to 48 (2015) and maternal mortality ratio from 560 to 174 during the same period. Though India missed MDG target of 42 and 140 respectively for these two indicators but the progress is remarkable. The estimated number of child deaths have come down from 3.2 million in 1990 to 1.1 million in 2015 which means 3,300 child lives saved every day!

However this progress does not commensurate with the economic and technology progress India has made. Our neighbouring countries with lesser development have made better progress. For example, the under-five mortality rate in the neighbouring counties of Sri Lanka, Nepal and Bangladesh is 9, 36 and 38 respectively, against 48 in India (Kumar S, Bothra V, Mairembam DS, 2016). Innovations in program and technology offers an opportunity to accelerate improvement in health in India. The ministry of health and family welfare has actively encouraged the state governments to innovate, identify innovations that address the burden of diseases, are cost effective and replicable. The government provides technical and financial support to scale them up. We look at how technology innovations in public health system in India can help accelerate its progress in improving health.

Opportunities

There are many opportunities available in India today for innovations. Indians have provided substantial inputs to digital revolution across the world. However within India we have only recently started efforts to harvest the benefits for the Indian population. The recently launched ‘Digital India’ strategy in 2014, has made many government services available online cutting down delays, red tapism and corruptions. A common man is making payment for day today necessities online or through mobile telephones saving time and money. A related initiatives to accelerate innovations in the ‘Start-up India’ campaign facilitates bank financing and creates a favourable business environment for start-up ventures including technology innovations. Similarly, the ‘Make in India’ launched in 2014, encourages Indian and multinational companies to manufacture technology and medical devices in India.

The global statistics shows that the 4.61 billion mobile users in 2015 from 4.01 billion in 2013. In 2017 the number of mobile phone users is forecast to reach 4.77 billion. Considering the challenge in grabbing this opportunity, there is a need to respond with service innovation. Overall, consumers and society will reap the fruits of this technological and socio-economic development. Data consumption is growing 65 percent annually for accessing services such as e commerce and e-learning.

Bharat Net’s aim is to connect India’s 250,000 Panchayats at an estimated cost of $18 billion. Health and education have been identified as priority areas to benefit from this connectivity. There are alternative approaches to connect India, including cable TV pipes and White spaces (refers to the unused TV channels between the active ones). These and many other opportunities are available in abundance today. The Digital India, National Skill Development Corporation,Swachh Bharat Abhiyan and Kayakalp Awards, creating ‘Smart Cities’ are some more opportunities to mention.

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Ministry of Health & Family Welfare promotes innovation in public health

Considering the tremendous potential in technology to compliment, accelerate effective implementation of health care, all the states have been encouraged to include innovations in the state programme implementation plans under National Health Mission (NHM). Annual national summits are held to recognize share successful efforts by the states. To facilitate this entire process including identification and review of such innovations a platform of ‘www.nhinp.org’ portal has been created. This allows uploading of innovations.

There are two categories of innovations program innovation and product innovation. Program innovation includes service delivery including referral, governance, treatment compliance, reduce cost of care or out of pocket expenditure etc. the product innovations include medical devices, innovative technologies including healthcare IT, m-health, and Tele-health/ E-health.

There are norms set for inclusion and exclusion of innovations. The inclusion criteria are –relevance to health needs, address endemic health problems and or diseases, facilitates accessibility, affordability, reduce cost of care, ensure quality and safety of healthcare product and process, and bridge skill gap required in service delivery. Similarly, the exclusion criteria are – Specific drugs, surgical or medical procedures or practices that need evaluation through one or more of the processes such as- Randomized controlled trials, Systematic Reviews, Meta-analysis etc, and Incomplete Documentation. The screening processes well laid out. This involves a six member screening group at NHSRC and an in depth reviews held by product and program committee.

In health, states are encouraged to propose innovation in program implementation plans for approval. In addition, to encourage and recognize the successful efforts, National Summits on Good and Innovative practices were initiated. In continuation, National Health Innovation Portal was launched by Shri. J. P. Nadda, Hon’ble Health Minister of India, in the year 2015. To strengthen and sustain the efforts further, Health Technology Assessment Workshops were held. In all, six such workshops with 325 participants were trained. To strengthen the whole effort, there has been health technology assessment trainings being conducted for non-invasive Haemoglobinometer and Glucometer, urine strip analyzer, SMS enabled patient monitor etc.

Table 1: Technology can help India leapfrog to improve health by addressing challenges, some examples:

Challenges		How technology can help: examples
Preventive Care
Health Promotion	Lack of physical activity, dietary intake, stress level	Mobile Apps to monitor physical activity, stress level, foodintake etc
	Lack of awareness of wellness, healthy lifestyle, mental illness, awareness on domestic violence	Films on Youtube and smartphone, mobile apps, SMS, Cloudbased screening and monitoring of mental health
Family Health including MCH	Lack of health record	Electronic Family Health Record for all family membersincluding those with NCDs linking it to UID, ANM Online
	Record of child and maternal care	Electronic Health record
	Lack of awareness	Mother and Child Tracking System Sending SMS to beneficiaries to alert them regarding services due to them, or services which have become overdue using M-health
Curative care
Disease outbreak	Lack of clinical and personal health data	Machine Learning based Predictive Analytics for providing hyper-personal, actionable insights.
	Lack of awareness and counselling (HIV/AIDS)	Mobile Apps for counselling, awareness, mobile apps for nurse, doctor for monitoring
	Lack of real time monitoring (Lymphatic Filariasis Mass Drug Administration)	SMS Reporting Program for ASHA
Access and Quality
Access to health care	Shortage of Doctors	E consultations, Any Time Medicine
	Shortage of specialists	Tele-medicine, tele-radiology, tele-ophthalmology
	Delay in fund flow and poor monitoring	Automation in Fund flow: PFMS
	Stock outs of drugs and other consummables	online tendering and monitoring linked to supply chain management such as E aushadhi in Rajasthan and similar initiatives in other states
Quality Monitoring Performance	Unsatisfied beneficiaries and in extreme cases become violent against health care providers	Patient feedback and grievance redressal system usingtelephone, internet etc
	long term patient records are not available	Interoperable Electronic Health Records connected electric family health record
	Delay in getting reports	Real time online dash boards
Hospital care	Problems with Record keeping, symptom monitoring,Psychiatric Patient localization, inventory management,supply chain management, lack of real time monitoring of hospital activities and data, medical device tracking and management, dialogue between patients, or between patients and health professionals, health promotion	Linking Family Health records with Electronic Health Record, Radio Frequency Identifier Devices, Smart cards, Kiosk, dashboard for reatime hospital monitoring, Data Analytics, Social Media, Internet of Thing

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Whole of population approach for addressing population health:

The world is moving towards promoting health among those who are healthy. Technology can help us in achieving this as traditionally people approach healthcare providers only after falling sick. Technology can help us in providing health related inputs to the whole population. The conceptual framework (Kumar S, Preetha GS 2012) is useful while addressing and ensuring health in a population. This framework broadly categorises the whole population in four sections (Fig. 2):

a. H ealthy Population (with no risk factors and no disease)
b. P opulation with Risk Factors
c. P opulation with Disease but not aware
d. P opulation known to have Disease

With the above categorization, the health efforts can be strategized and concentrated, for example – provision of preventive and promotive health services to the population categorised as (a) Healthy population; screening and promotive health services, (b) building resilience for population categorised as Population with risk factors; early detection, treatment and care including limiting disability and rehabilitation along with healthy lifestyle for category (c); and compliance to treatment and care along with healthy lifestyle for category (d) which is known to have disease.

Is technology innovation addressing major killers?

At this stage, it is very essential that we look at what are the major causes of death in India and address these. The seven major causes of deaths in India were prominently evident from WHO’s India Country Profile of Burden of Disease, NCD 2014. Accordingly, in all 98, 16,000 lakhs estimated deaths took place in India. An estimated 27,48,480 (28%) deaths can be attributed to communicable, maternal, perinatal and nutritional conditions put together, 25, 52,160 (26%) to cardiovascular diseases, 12,76,080 (13%) to chronic respiratory diseases, injuries taking toll of 11,77,920 (12%), cancers causing 6,871,20 (7%), diabetes 1,96,320 (2%) and other NCDs being 11,77,920 (12%).

Above understanding regarding causes of deaths in India shall not only inform the overall planning towards actions required for addressal but could be complemented by technological.

Some Innovations that can revolutionise healthcare in India:
Family health folders:

This has been another initiative which looks at family as a unit and tries to maintain health record for each and every member which could be linked and segregated for individual service like immunization, antenatal care, postnatal care, spacing methods, next month’s medicines, BP records etc. this initiative has been piloted in AIIMS and INCLEN projects in some of the states like Rajasthan called Jan Swasthya, Madhya Pradesh and in Himachal Pradesh by the name of ANMOL. There is a provision of print work plan for next day/ week/ fortnight/ month. Also, it can be linked with the Electronic Medical Record (EMR).

Electronic Health Records (EHR):

Government is working on EHR to ensure continuity and quality of care. EHR will help in recording disease episodes and core plans and would allow data portability between different providers. Also, the metadata and data standards have been developed for it. Not only between clinical systems but also between support systems such as HR, Finance, Logistics, Lab, Emergency Transport FHR etc.There is also a possibility of establishing linkage to UID (Aadhar card).

Access: Free essential drugs:

To widen the accessibility of free drug services, there is a web based supply chain management system (e-Aushadhi) has been created. This system allows online tracking of drug inventory. It enables steamlining of inter-drug warehouse transfer and efficient control of inventory. Also, it enables multi users and multi-location for storage. This initiative has been implemented by various states like Rajasthan, Tamil Nadu, Andhra Pradesh, Odisha, Jammu& Kashmir and at various stage in other states.

Access: Healthcare Any Time Medicine (ATM):

Presently, there are about 25 percent PHCs without a doctor, in India. This calls for innovative approach to address the challenges and originated an innovation called AT M. AT M, piloted by National Health Systems Resource Centre, New Delhi, provides Tele-consultation supported with mobile phone and the generic drug vending machine. The pilots have been conducted in five states [HP, Odisha, MP (3-4 each), UP (100) and AP (100). Total cost of this initiative per facility has been only 3 lakhs.

Access: Telemedicine:

Yet another example for use of technology is ‘Telemedicine’ which is very successfully piloted in states like Tripura, Andhra Pradesh, Bihar, Maharashtra and Assam. With this technology, images and scans can be easily sent across the specialists for diagnosis and consultation for treatment; especially when specialized treatment is required and is not easily available nearby.

Automation of fund flow:

It has been the experience so far that programme activities suffer due to delay in fund transfer and in this context establishing public fund management system with the use of technology is a bliss. With this, automation of recording, verification and calculation of payments are done a smoother and faster way and electronic fund transfer (EFT) towards payments into recipient’s bank account becomes easy. This technology has been utilized in states like Rajasthan- with ASHA Soft, in Bihar- namely HOPE and Delhi.

To simply sum up, it is obvious that the technology can address access to and quality of health care in India. Many initiatives across the country exist and therefore there is a need to identify cost effective, scalable innovations which address bottlenecks and the burden of diseases. To enable this, there is a platform provisioned called National Health Innovation Portal, in India. This is an effort of Ministry of Health & Family Welfare commitment to support scale up of good and replicable practices in public health in India. There is a need to encourage innovations and the government must make resources available to scale up the promising innovations to reach the last beneficiary.

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