Dr. Sanjiv Kumar Archives - InnoHEALTH magazine

Transforming Public Health: Addressing Challenges and Shaping the Future

Khushi Khandelwal — Thu, 02 Jan 2025 06:30:00 +0000

Prof.(Dr.) Sanjiv Kumar

In the ever-evolving field of public health, experts like Dr. Sanjiv Kumar is at the forefront for paving the way for change. In a recent episode of the InnoHEALTH Podcast, Dr. Kumar shared his valuable insights on the challenges, opportunities, and future directions of public health in India. As a seasoned public health expert, his perspectives offer a roadmap for navigating the complexities of healthcare in the 21st century.

Enhancing Healthcare Accessibility

One of the most pressing issues discussed was healthcare accessibility. Prof. Kumar noted that despite significant advancements, there remains a stark disparity in access to healthcare services, particularly in low- and middle-income countries. He argued that healthcare should be a universal right, not a privilege reserved for those in urban or economically advantaged areas.

To address these disparities, Prof. Kumar suggested several strategies. He advocated for the expansion of mobile health units that can reach remote and underserved communities, providing essential medical services and screenings. Additionally, he highlighted the potential of telemedicine to bridge the gap in areas where physical healthcare infrastructure is lacking. However, he cautioned that the success of these initiatives hinges on the availability of internet connectivity and digital literacy in these regions.

Prof. Kumar also stressed the need for governments and international organizations to invest in strengthening healthcare systems in these countries. This includes not only building physical infrastructure but also training local healthcare workers and ensuring that they have the necessary resources to deliver quality care.

The Shift Toward Preventive Healthcare

Prof. Kumar devoted a significant portion of the discussion to the concept of preventive healthcare. He argued that healthcare systems worldwide are overly focused on treating diseases rather than preventing them. This reactive approach, he suggested, is unsustainable in the long term, particularly as populations age and the prevalence of chronic diseases increases.

Preventive healthcare, according to Prof. Kumar, should be a priority for both policymakers and healthcare providers. He advocated for increased public health education, encouraging people to adopt healthier lifestyles that reduce the risk of diseases such as diabetes, heart disease, and cancer. Prof. Kumar also pointed to the importance of regular screenings and early detection programs, which can significantly improve outcomes by catching diseases at an earlier, more treatable stage.

He called for more investment in community-based programs that empower individuals to take charge of their health. These programs, he argued, should be tailored to the specific needs of different populations, taking into account cultural, social, and economic factors that influence health behaviors.

Addressing the Healthcare Workforce Crisis

The conversation also covered the challenges faced by the healthcare workforce, particularly in light of the COVID-19 pandemic. Prof. Kumar acknowledged the extraordinary efforts of healthcare workers during the pandemic, but he also highlighted the significant strain that the crisis has placed on them.

He noted that many healthcare systems are grappling with a shortage of trained professionals, which has been exacerbated by the pandemic. This shortage not only affects patient care but also contributes to burnout and mental health issues among healthcare workers.

To address this crisis, Prof. Kumar proposed a multi-faceted approach. He called for better support systems for healthcare workers, including mental health resources and professional development opportunities. Additionally, he emphasized the need for policies that promote the recruitment and retention of healthcare professionals, particularly in underserved areas.

Prof. Kumar also discussed the importance of creating a more resilient healthcare workforce, capable of adapting to future challenges. This includes investing in continuous education and training programs that keep healthcare workers up to date with the latest medical advancements and technologies.

Digital Transformation in Healthcare

Digital transformation was another key theme in the discussion. Prof. Kumar highlighted how the healthcare industry is increasingly leveraging digital technologies to improve care delivery, enhance patient outcomes, and reduce costs. From electronic health records to AI-driven diagnostic tools, technology is revolutionizing the way healthcare is provided.

However, Prof. Kumar cautioned that the digital divide poses a significant challenge to the widespread adoption of these technologies. He stressed that efforts to digitalize healthcare must be accompanied by initiatives to ensure that all populations have access to the necessary tools and training. This is particularly important in rural and remote areas, where digital infrastructure may be lacking.

Moreover, Prof. Kumar emphasized the importance of data security and privacy in the digital age. As healthcare systems become more reliant on digital tools, safeguarding patient information from cyber threats becomes paramount. He called for robust cybersecurity measures to protect sensitive health data and maintain trust in digital healthcare systems.

Policy and Regulation: Shaping the Future of Healthcare

Finally, Prof. Kumar touched upon the role of policy and regulation in shaping the future of healthcare. He argued that effective healthcare policies must be grounded in evidence and informed by the realities on the ground. Policymakers, he suggested, should engage with healthcare providers, patients, and communities to develop regulations that are both practical and equitable.

Prof. Kumar also discussed the need for international collaboration in addressing global health challenges. He pointed out that many of the issues facing the healthcare industry, such as pandemics, antibiotic resistance, and climate change, transcend national borders. As such, global cooperation is essential in developing solutions that benefit all of humanity.

In conclusion, Prof. Sanjiv Kumar’s discussion provided a comprehensive overview of the current challenges and opportunities in the healthcare sector. His insights offer valuable guidance for professionals, policymakers, and communities striving to create a more accessible, sustainable, and equitable healthcare system. As the healthcare industry continues to evolve, the themes highlighted by Prof. Kumar—communication, accessibility, preventive care, workforce support, digital transformation, and effective policy-making—will undoubtedly play a crucial role in shaping its future.

Authors biography

Dr. Sanjiv Kumar has vast experience of 47 year in the national and International arena and plays a significant role in many healthcare policies. He received several national and international accolades and awards.

The post Transforming Public Health: Addressing Challenges and Shaping the Future appeared first on InnoHEALTH magazine.

Health should start with public

InnoHEALTH Magazine — Mon, 19 Feb 2018 06:41:37 +0000

Initiating the discussion on the subject of Public Health and Biotechnology, Dr. D. Prabhakaran emphasized the need to start with working with collated data, for the purpose, from the location and find solutions that are unique to that area.

Keynote Address: Dr. D Prabhakaran
Moderator: Dr. V.K Singh
Panelists:
• Dr. Jaanus Pikani
• Dr. Pranav Gupta
• Dr. Sanjiv Kumar
• Maj Gen Jagtar Singh

Citing the example of global data about Diabetes, Dr. Prabhakaran brought to the notice of the audience that what is relevant to a specific area may not be applicable elsewhere, hence not very usable for health service providers in that region.

This is very important and relevant as biotechnology can be best put to use with good quality data for a specific region and disease. “We need to understand the mechanism of the disease. Innovations are needed in the management of acute illness. You, also, need data to apply biotechnology at its best and develop guidelines. Especially for contagious diseases, we need to keep track of various demographic realities on ground through good quality data that should be available to medical experts, without any corruption in the data,” said Dr. Prabhakaran.

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He concluded his thoughts on the problems with suggestions that what is required is a simple device available at the location and operational without the need of any complex operations. We need to develop such devices for monitoring of communicable devices that can be used for self monitoring, patient management in hospitals and screening.

In contrast to the scenario above, Maj Gen Jagtar Singh, an expert in the field of medicine with our armed forces sketched a very different scenario and raised very relevant points.

“Outbreaks are a huge threat in the army as we have a large body of human beings living together. For this we have a large army of efficient doctors and medical staff to contain such outbreaks”, he explained.

He continued his thoughts on the same and said, “The second challenge is harsh ground realities as our soldiers work in extreme conditions. To treat them at these extreme conditions, the Indian army has done some specific research that has been accepted all over the world and not just with our soldiers.

“In the field of acclimatization, we are working with innovative approaches to cut down the acclimatization period and counting on such platforms as this to understand our unique problems and extend their service to find acceptable solutions,” concluded Maj Gen Jagtar Singh.

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Dr. Jaanus Pikani has been an active member of the team that orchestrated transition of the Estonian health care from the Soviet type system to the most cost-efficient health care system globally recognized by the World Bank. Dr. Pikani was among the initiators and architects of the Estonian Genome Project, a globally unique population based health and genome databank of 50,000 participants or 5% of Estonian population, as of now.

Highlighting this as a new yardstick of providing public health, he shared that the Genome Project is now supported by various European states and in fact has reached as far as Vietnam and around. European countries and the World Bank have been in support of the project and eagerly back the project with good intentions.

Dr. Pikani feels that what they have achieved may be small in number especially when compared to India, but the same can be replicated with faith and dependence on technology and innovations.

Highlighting the efforts and intentions of the Government of India, Dr. Sanjiv Kumar, Director of the International Institute of Healthcare Management (IIHMR) shared his excitement regarding the positive steps of the government. “I am excited about the shape of things to come in the near future with acceptance and adaptation of innovations and new technology.”

In fact, he took a very encouraging approach and said, “Technology is available in your pocket for your good health. Starting with your smartphone, by which you can count the steps you take and the calories that you burn in a day, innovation hence has already become part of our lives and us our using technology of today with the very innovative approach and amazing outcomes.”

“Even the shortage of doctors or specialists is taken care of by telemedicine or long distance consultation. This is not in the future, but is, in fact, happening with the best of the doctors and specialists being consulted by clinics and medical facilities from all over the country – some as newly-formed private establishments or many more backed by the government to maximize the utilization of doctors and specialists who are in terrible shortage.”

All the panelists unanimously voiced their positivity about the fact that the health and medical field in India has been most encouraging in embracing innovations and new technology with amazing results.

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“Traditionally developing medical devices is very capital intensive with years of R&D that adds to the cost and makes it very unviable for the product to be of any commercial viability. The best way forward is to produce products that are of need by the doctors and not indulge in ambitious research programs that can take as long as 4-5 years of development time and just the rearch can cost a couple of million of dollars.”

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“Life cycle of a diagnostic device is not predictable as some competition may arrive in the market within six months of its launch, with additional facilities, extra benefits and probably at a cheaper cost. And there are other factors that can contribute to failure of the product despite it being very innovative and technically superior. For this you need Curators for startups or need big corporate to invest in service and maintenance for new innovative products.”

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“Cost of innovation is always high as it involves immense research and investment in resources with no guarantee of market share. Government establishments like the Andhra Metric Zone and Abdul Kalam institute have come to the rescue of such innovators who need hand-holding by someone for making new products commercially viable and relieving the inventor of such mental burden. Only such marriage between innovators and non-profit establishments can ensure innovations to be introduced at reasonable price – not necessarily at a cheap rate, but affordable.”

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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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