Sri Lanka Archives - InnoHEALTH magazine

A Right Gesture Saves Life

InnoHEALTH Magazine — Tue, 15 May 2018 08:47:43 +0000

The writer is an accomplished Plant Scientist with +15 years of R&D experience with specialization in cereal & pulse crop biochemistry and genomics. An ex-Research officer at the University of Saskatchewan, Saskatoon, Canada and served in different capacities for eight years. She has been awarded twice for the category ‘Young Scientist (Indian Society of Plant Physiology & KK Nanda Foundation for Advancement of Plant Sciences). She also serves as an Honorary Advisor to various reputed firms and reviewer of multiple Journals of International repute.

Greeting gestures, a language of paying honour, respect, love, adoration, graciousness, empathy towards each other. It is a global custom and has multiple variations. Each country has its own customized version and ritual. The most popular version i.e. hand-shake probably has its roots in Great Britain. Men in the United States will usually shake hands when greeting each other, but it’s not usual for them to kiss when greeting. Americans in addition to handshaking also do a fist bump, wave and hug.

For English people, the handshake is the formal way of greeting when meeting someone new. In informal situations, both men and women use a quick kiss on the cheek, and for women who know each other well. Handshake works universally as a professional way to greet. It is a little firm in Germany, more extended (3-step handshake) in Botswana and for Malays, it extends to touching each other’s fingertip followed by their hearts. Filipinos take a hand of their elders and press it to their foreheads called as ‘Mano’.

The second most common way to greet is kiss (or cheek kiss). A kiss represents intimacy and accepted as a cultural norm in European countries and Latin America. The right-left-right alternate cheek kiss thrice is common in Russia, Poland, Slovenia, Serbia, Macedonia, Montenegro, the Netherlands, Iran and Egypt while twice in Bosnia, Herzegovina, Italy, Hungary and Rome. One kiss is required in Mexico and Belgium. In Galapagos, women restrict kiss on the right cheek only. French people kiss twice or even five times depending upon the region. Two kisses and back slap is famous in Greece. Kiss goes always with a hug if you are in Argentina.

One of the common practices is ‘pecking’ or brushing each other’s cheek with a sound of a kiss. In Greenland, they often press their nose and upper lip against the cheek or forehead and take a deep breath (Kunik), similar to a mother embracing her child. Saudi Arabia, UAE, Oman and various gulf countrymen show their welcome respect by ‘touching their noses’ as greeting gesture. In New Zealand, it takes another variation in form of ‘forehead touching’.

In South Asian countries, people do ‘Añjali Mudra’ in which they show their humility by placing palm together like a prayer and tilting their head forward in respect to other people which is referred as ‘Wai’ in Thailand, ‘Sampeah’ in Cambodia and ‘Namasté’ in India. Sri Lanka, Nepal, Bhutan, Laos, Burma and Indonesia follow similar gestures.

Namasté reflects not only recognition of another’s physical presence, but also of their spiritual presence. Namasté is a greeting of another’s spirit or reverence. Namah means “bow”, “adoration” and the means “you”. In other words,” I bow to you.” Flexing hands in Namasté pose releases the tension that activities like typing creates in the tendons in the wrists. It also calms the mind, helping to reduce stress and anxiety.

Anybody can say a polite gesture of love and respect. Indians take blessing from elders by complete bowing while touching feet of elders referred as ‘pranam mudra’. Bowing with no physical contact is standard greeting practice of Japanese and Chinese. Tibetan monks stick their tongue out to greet people. They also press the hands together and place them in front of their chest to show that they “come in peace”. In South Asian, various Muslims often greet through ‘adaab’ gesture. It involves bending forward the upper torso, raising the right hand towards the face with palm inwards such that it is in front of the eyes and the fingertips are almost touching the forehead. The other countries of the world have also evolved their special ways to greet people as per their culture.

One of the major health and environmental challenge we face today is rapid emergence of novel pathogens. The spread of these pathogens, especially of nosocomial origin (hospital based), is often linked to cross-contamination by healthcare workers and ways of greeting gestures while meeting each other. An idea of handshake-free zones in hospitals have encouraged awareness. But also questioned how a doctor will take the physical examination without touching a patient. On the other hand, we cannot ignore the fact that microbes like Acinetobacter calcoaceticus, Enterococcus faecalis, E. faecium, and Shigella dysenteriae type 1 can sustain on hand surface upto one hour while Pseudomonas aeruginosa and Burkholderia cepacia survive up to 30 minutes. Rotavirus might survive for 20 min while the viability of human parainfluenza virus is nearly 60 min.

Studies indicate that a contaminated hand can transfer its viable contamination to seven different subjects or surfaces. One of two common items is a clean paper towel and soap dispenser with average transfer rate ranges between 0.01% to 0.64% and 12.4% to 13.1% respectively. We touch our face nearly 2-5 times a minute i.e., 2000 to 3000 times a day. In fact, whatever contamination we have on our hands is also getting transferred to our face. We may wonder whether our hand soap is capable of killing all the potentially pathogenic microbes. Are we washing our hands correctly and does it really help? We often use hand wash, sanitizers without giving attention to their content and standards. Do they qualify for antimicrobial purpose? Moreover, our greeting gestures further contribute to the spread of the germs.

For healthcare workers, the protected physical contact is a non-avoidable choice. Healthcare workers and doctors should change their gloves while switching from one patient to another. Avoiding greetings which involve physical contacts especially during outbreaks can provide a preventive approach to managing outbreaks. Hospitals need to improve compliance with hand hygiene. Handshake free zone can be one alternative in hospitals. But they aren’t designed to replace hand washing but to complement it. Creating handshake free zone will also bring attention to the hands as vectors for disease. It will also improve compliance with hand hygiene and an easy and inexpensive way to reduce infections.

It is rude to not to shake a hand if a person extends its hand towards you in the name of trust and honour. We can’t be rude to others but why not to adopt ‘Anjali Mudra’, Wai, Namasté, Wave, Bowing or Adaab to greet. This respectable way of greeting with no physical contact should be adopted in the healthcare settings. In India, by adopting our age-old greeting method especially in a healthcare setting can shield us from many invisible microbial infections. We just need to adopt, practice and re-practice these gestures to decrease the spread of infections.

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Lifestyle diseases: A threat to backward states

InnoHEALTH Magazine — Wed, 02 May 2018 08:13:02 +0000

Lifestyle diseases like chronic respiratory and heart diseases are killing more people in India than communicable ailments like Tuberculosis (TB) or Diarrhea in every states, including most backward belts, says the India State-Level Disease Burden Initiative’s Report.

Among the leading non-communicable diseases, the largest disease burden or Disability-Adjusted Life Year (DALY) rate increase from the period of 1990 to 2016 was observed for diabetes at 80 per cent, and ischaemic heart disease at 34 per cent.

In 2016, three of the five leading individual causes of disease burden in India were non-communicable, with ischaemic heart disease and chronic obstructive pulmonary disease as the top two causes and stroke as the fifth leading cause. The range of disease burden or DALY rate among the states in 2016 was nine-fold for ischaemic heart disease, four-fold for chronic obstructive pulmonary disease, and six-fold for stroke, and fourfold for diabetes across the country.

The key metric used in the study is DALYs, which is the sum of the number of years of life lost due to premature death and a weighted measure of the years lived with disability due to a disease or injury. The use of DALYs to track disease burden is recommended by India’s National Health Policy of 2017.

While ischaemic heart disease and diabetes generally had higher DALY rates in states that are at a more advanced epidemiological transition stage toward non-communicable diseases, the DALY rates of chronic obstructive pulmonary disease were generally higher in the Empowered Action Group (EAG) states that are at a relatively less advanced epidemiological transition stage.

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The report shows that communicable diseases constitute almost two-thirds of the disease burden in India from a little over a third in 1990. Despite the transition, which is associated with development, malnutrition remains the single top risk for health loss.

All states have thus made what’s called the ‘epidemiological transition’ there remain wide variations in their disease profiles with some having made that transition as early as 1986, and others as recently as 2010.

The first group to make the transition in 1986 included Kerala, Tamil Nadu, Goa, Himachal Pradesh and Punjab. The last group to do so, accounting for the highest number of people (588 million), made the transition almost a quarter of a century later, in 2010. This group included Bihar, Uttar Pradesh, Madhya Pradesh, Chhattisgarh, Jharkhand, Rajasthan and Odisha. India as a country made the transition in 2003.

The Report’s executive summary says with almost one-fifth of the world’s population living in India, the health status and the drivers of health loss are expected to vary between different parts of the country and between the states.

Accordingly, effective efforts to improve population health in each state require systematic knowledge of the local health status and trends. While state-level trends for some important health indicators have been available in India, a comprehensive assessment of the diseases causing the most premature deaths and disability in each state, the risk factors responsible for this burden, and their time trends have not been available in a single standardised framework.

The Report finds that the Health status improving, but major inequalities between states Life expectancy at birth improved in India from 59.7 years in 1990 to 70.3 years in 2016 for females, and from 58.3 years to 66.9 years for males.

There were, however, continuing inequalities between states, with a range of 66.8 years in Uttar Pradesh to 78.7 years in Kerala for females, and from 63.6 years in Assam to 73.8 years in Kerala for males in 2016.

The per person disease burden measured as DALYs rate dropped by 36% from 1990 to 2016 in India, after adjusting for the changes in the population age structure during this period. But there was an almost two-fold difference in this disease burden rate between the states in 2016, with Assam, Uttar Pradesh, and Chhattisgarh having the highest rates, and Kerala and Goa the lowest rates.

While the disease burden rate in India has improved since 1990, it was 72% higher per person than in Sri Lanka or China in 2016. The under-5 mortality rate has reduced substantially from 1990 in all states, but there was a four-fold difference in this rate between the highest in Assam and Uttar Pradesh as compared with the lowest in Kerala in 2016, highlighting the vast health inequalities between the states.

Large differences between states in the changing disease profile of the total disease burden in India measured as DALYs, 61% was due to communicable, maternal, neonatal, and nutritional diseases (termed infectious and associated diseases in this summary for simplicity) in 1990, which dropped to 33% in 2016. There was a corresponding increase in the contribution of non-communicable diseases from 30% of the total disease burden in 1990 to 55% in 2016, and of injuries 18 %.

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Indian scientists detect new strain of dengue

InnoHEALTH Magazine — Tue, 10 Apr 2018 08:55:07 +0000

Scientists at Pune-based National Institute of Virology (NIV) have found a new genotype of dengue virus in patients who suffered due to one of the worst epidemics in recent years in Tamil Nadu. The study shows that the strain originated in Singapore and emerged in Tamil Nadu in 2012 and Kerala in 2013.

Even a single cell bacterium has not only DNA but also cell organelles. But viruses are just bits of DNA material in a wrap, and they use cellular mechanism of the host to multiply themselves. In doing so they damage the infected cells. The immune system of the body responds with production of specific antibodies, which destroy specific viruses.

Dengue virus comes in different types and each with different flavours. There are four serotypes of dengue virus – DENV-1 to 4. Each of them has multiple genotypes. The genotype variation can be subtle either in DNA material or the envelope. For example, DENV-1 comes in as many as five genotypes – Asia, South Pacific, Thailand, Malaysia and AM/AF.

When infected first time, the patient developed a life time immunity for that serotype due to presence of antibodies produced earlier. However, if the secondary infection is by another serotype, the immune system is confused, and the infection can become life threatening.

“Dengue virus has four antigenically defined serotypes and each serotype has multiple genotypes with several clades based on phylogenetic analysis of envelope or whole genome sequences” says D Cecilia of the Dengue Group at ICMR-NIV, Pune, who is the lead author of the new study. This makes developing an effective vaccine a major challenge.

During the last five years, the National Vector Borne Disease Control Programme (NVBDCP) reported 80,725 cases of dengue per year with a fatality rate of about 0.24%. The ten-year data for Tamil Nadu, 2007–2016 show an average of 2539 cases per year with fatality of 0.21%. This is less than the national average. However, during 2012 the cases spiked to 12,826 and deaths rose to 66, which implied fatality of 0.51%. This was a clear signature of a dengue epidemic. Epidemiological studies indicated that Tirunelveli in Tamil Nadu was the epicentre of the epidemic.

Past research had shown that the emergence of new genotype was the cause of the major dengue outbreak in late 1980s in India. Taking a cue, scientists led by Dr Cecilia collected blood samples from patients in South India during the 2012 outbreak with the help of Vellore-based Christian Medical College. The genome sequence of the virus collected from the samples were compared against the GenBank library which hosts all known dengue virus samples from 1943 to 2015.

The study revealed that DENV-1 Asian genotype had replaced the AF-AM type that was hitherto dominant in Tamil Nadu. “All four serotypes were circulating but DENV-1 was dominant, present in 52% of the serotyped samples” says Cecilia. Further, the study showed that the DENV-1 Asian genotype had also developed a new phenotype in the E gene. “This is the first time after 20 years we are observing change in genotype in India,” the scientist added.

DENV-1 originated in US and Japan during 1932. However, the Asian genotype of DENV-1 that emerged in Thailand. The Indian strains that caused havoc during the 2012-15 emerged in Singapore sometime in 2005. The same strain caused an epidemic in Singapore in 2005 and later in 2009 in Sri Lanka. “Phylogenetic analysis revealed that the Asian genotype was introduced from Singapore and shared 99% similarity with viruses, associated with large outbreaks in Singapore and Sri Lanka. The movement of DENV can affect dengue outbreaks and underscores the need for close molecular monitoring of DENV,” says Dr Cecilia.

The findings are published in journal Virology. The research team included D. Cecilia, J.A. Patil, M.B. Kakade, A. Walimbe, K. Alagarasu, B. Anukumar, from National Institute of Virology and A. Abraham from Christian Medical College, Vellore.

(Article shared from India Science Wire)

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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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