UNICEF Archives - InnoHEALTH magazine

Post Antibiotic World

InnoHEALTH Magazine — Mon, 18 Nov 2019 09:25:20 +0000

Like the ‘guardians of the galaxy’ the futuristic prospect of this world will be a place where the microbes have become resilient against antibiotics and the fight against infection has ceased to find its way through antibiotics. Though most of the antibiotics that are consumed are metabolized by the body, a negligible amount is passed through us as waste, which is further carried to wastewater treatment plants.

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The basic methodology to clean the wastewater in plants is through membrane bioreactor that uses both biological as well as filtration process where bacteria are acclimatized to consume the waste products and help in metabolization. The antibiotic waste breakdown by bacteria often expresses resistance genes that reduce the effectiveness of the medicines. In the long run, the horizontal gene transfer develops whose expression pass from one generation to the next and the resistance genes gain prominence over the years. With the passing phase, the bacteria grow and thrive itself therefore often giving rise to biomass. The biomass is produced in tonnes by wastewater plants nearly every day. After treatment, they are often disposed of as landfills, fertilizers for agriculture and feed crops for livestock. A minute quantity of resistant bacteria and free-floating DNA often finds its way through effluent of the pharmaceutical industries. The studies have further shown that gene elements called plasmids carry resistance genes for several different types of antibiotics, therefore, resulting in a positive correlation between one type of antibiotic and the resistance gene of another. It creates a dangerous dormant situation that can erupt like an active pandemic under the favourable situation. Plasmids are a thousand times smaller than bacteria and their free-floating nature often surpasses the treatment barriers of the filtration system of the treatment process, therefore making exit through effluents. They further contaminate the surface water and groundwater – the two important sources of drinking water. Researchers have found that even low concentrations of just a single type of antibiotic in the water supply leads to resistance in multiple classes of antibiotics and hence leads to antimicrobial resistance (AMR).

Also Read: Health Card of Indian States

Water, as we all know, is the utmost need of our survival. Human body comprises around 60% water and the fact that less consumption of water leads to various diseases in the future. Apart from facts and figure, one simple question we often forget to inquire is where this water is coming from? Surface water i.e. lakes, rivers and ponds or groundwater i.e. tube wells, bore well, well as these are the two sources that give us a glass of water.

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Our health concern and the credulous brainwash of our mind by the various available water filter present scenario and save our planet from the harmful effect of self-made destruction.Effective treatment and management of wastewater from the pharmaceutical industry will help in overcoming antimicrobial resistance. Advanced treatment methods such as reverse osmosis, nano filtration, and membrane bioreactors have shown to be promising processes for cleaning micro pollutants with nano gram per litre (ng/L) concentration levels.The nation where the trial/testing of most of the antibiotic occurs, there are rarely any constraints implemented on the disposal of pharmaceutical wastewater to the surface water. The current scenario of environmental issue foresees that in the near future there will be scarcity of drinking water and our hope was restored when global challenge was taken to in the market often diverts us from our prime concern of keeping our planet safe from water pollution. The pollution of water bodies has been initiated by us and still we are invariably helping it grow with every passing day. As discussed earlier, the various point sources from domestic to industrial pave the way for antibiotic to contaminate the water bodies. According to the latest report of UNICEF, 2.1 billion people lack the access to clean and safe drinking water.

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How do we remove the problem? What do we do to save ourselves from the harmful effects?

The encouraging words of Normal Vincent Peale, American author ‘Every problem has in it the seeds of its own solution. If you don’t have any problems, you don’t get any seeds’ gives us the hope that we will successfully overcome the present scenario and save our planet from the harmful effect of self-made destruction.Effective treatment and management of wastewater from the pharmaceutical industry will help in overcoming antimicrobial resistance. Advanced treatment methods such as reverse osmosis, nano filtration, and membrane bioreactors have shown to be promising processes for cleaning micro pollutants with nano gram per litre (ng/L) concentration levels.The nation where the trial/testing of most of the antibiotic occurs, there are rarely any constraints implemented on the disposal of pharmaceutical wastewater to the surface water. The current scenario of environmental issue foresees that in the near future there will be scarcity of drinking water and our hope was restored when global challenge was taken to curb the antimicrobial resistance from environment. Remedial measures taken towards eradication are further discussed.

Also Read: Rising burden of non-communicable diseases

Political commitments: International efforts: World Health Organization Jaipur declaration on antimicrobial resistance 2011 recognized AMR as a serious public health threat. With the 2014 WHO Report, the extraordinary rates of AMR prevalent in India came into focus. After this report, joint efforts were made by India and WHO. While WHO labelled AMR as the Flagship Priority area for South East Asia Regional Office (SEARO), the Indian Medical Association launched an awareness programme to train the physicians and sensitize the general public. In 2015, the 68th World Health Assembly decided to incorporate the concept of One Health in the fight against AMR and a Global Action Plan was initiated. All member countries, including India, agreed to frame their own National Action Plans (NAPs) for AMR by 2017.

Also Read: Specific health situation of Indian states

National efforts: The Government of India formulated a Core Working Group on AMR that drafted a NAP for the country. Six strategic priorities were listed in NAP, all of which incorporated considerations for AMR in the environment, directly or indirectly. Further, each strategic priority has defined interventions, activities and outputs, the fulfillment of which is delineated by a timeline projected for the next five years. The NAP, although promising, has not yet come into full action in any of the Indian states so far. To curtail the prevalent malpractice of over-the-counter (OTC) sale of drugs, the Central Drugs Standard Control Organization implemented Schedule H1 in India in 2014. It, however, encompasses only a few selected antimicrobial groups. In June 2017, the Food Safety and Standards Authority of India (FSSAI) published the list of maximum residue levels for antimicrobials in foods prepared from animal, poultry and fish.

Health Organization in India: To know the near-exact extent of AMR, AMR surveillance networks were initiated by the Indian Council of Medical Research (ICMR) and the National Centre for Disease Control (NCDC) in 2013 and 2014, respectively. In 2015, these two organizations along with the support from Centers for Disease Control and Prevention (CDC) USA, started a systematic assessment of the prevailing IPC practices in India with the aim of formulating new guidelines for preventing hospital-acquired infections.

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These activities, however, cater basically to the emerging AMR in the healthcare settings and do not include special provisions for AMR in the environment. Similarly, the National Health Mission’s National Health Systems Resource Centre and the National Accreditation Board deal with IPC practices and strengthening of laboratories/hospitals and not with the AMR in the environment per se. The importance of AMR in the environment has been realized recently by the national health authorities and The National Health Policy 2017 calls for a rapid standardization of guidelines regarding antibiotic use, limiting the use of antibiotics as OTC medications, banning or restricting the use of antibiotics as growth promoters in animal livestock, and pharma co-vigilance including prescription audits inclusive of antibiotic usage – in the hospital and community.

Innovative ideas: The National Health Mission of India started the Swachh Bharat Abhiyan or the Swachh India Mission to improve the basic hygiene and sanitation in all spheres of life. As a part of this massive programme, education was imparted through mass media on the health hazards of open defecation. UNICEF data shows that out of one billion openly defecating people in the world, 60 percent reside in India. It is further argued that it is a behavioural problem with the Indians as other poverty struck nations of Africa and South East Asia did not have the problem of open defecation to this an extent. To deal with such socio-cultural issues, innovative ideas along with mass media are needed in India.

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So far in India, antimicrobial resistance in the environment has been a topic of least priority. With an ever-increasing threat of AMR in the environment, immediate action is required to halt its progress and spread. A combined effort of multidisciplinary and multi-sectoral approach will be able to eradicate the problem in the near future.

About the author

Dr. Debleena Bhattacharya is an independent researcher. She is presently working as an Assistant Professor in the Department of Environmental Science and Engineering at MEFGI, India. She holds a doctoral degree in Environmental Science from IIT (Indian School of Mines) Dhanbad (India). Her specialisation is in the field of wastewater treatment and biotechnology.

The post Post Antibiotic World appeared first on InnoHEALTH magazine.

Digital Safety Plan for Children

InnoHEALTH Magazine — Thu, 23 Aug 2018 07:06:31 +0000

A digital safety plan for children being leveraged; zero tolerance towards violence against children need of the hour.

Fresh from her experience in managing emergency situations, Dr. Yasmin Ali Haque smilingly handles the tsunami of problems as UNICEF’s Representative in India, lying next to her home Bangladesh.

She says UNICEF is working closely with the government in developing a comprehensive plan on digital safety for children. Digital literacy is key to ensuring that all boys and all girls stay informed, engaged and safe online. There is a need to galvanize the ‘zero tolerance’ towards violence against children. In a detailed interview to InnoHEALTH magazine, she answered a wide range of questions and elaborated at length, UNICEF’s programmes in India where the safety of children is emerging as a major concern.

Dr. Yasmin had joined as the UNICEF Representative in India in July last year and prior to that, she was Deputy Director of UNICEF’s Office of Emergency Operations where she played a leading role in the programming and policies for an effective UNICEF response for children in humanitarian crisis. She started her career in UNICEF in 1996 and held many appointments in challenging situations.

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Q. UNICEF is guided by the Convention on the Rights of the Child (CRC) and strives to establish children’s rights as enduring ethical principles and international standards of behavior towards children. UNICEF responds in emergencies to protect the rights of children. What are your views are the steps that can be taken to protect children from violence and to ensure their safety?

One important facet of the rights of CRC is to ensure that children grow in a protective and safe environment, free of any kind of violence and abuse. Preventing and responding to sexual violence requires strong collaboration among stakeholders from diverse walks of life. UNICEF is committed to working with the government, civil society organizations, corporates, media and all the other stakeholders to support society and families to ensure that children are safe and free from abuse and exploitation. Guided by the CRC, it is imperative to act now to break the cycle of violence against children and protect survivors of violence.

In recent years, India has made significant progress in addressing sexual abuse against children by having enacted legislation and acted on a large number of cases. The public has also become increasingly aware of sexual abuse cases that may have gone unnoticed years ago due to an increase in reporting on the issue. Digital media and immediate reporting have also contributed to this awareness. Still, a lot more needs to be done. Building on these positive developments, UNICEF collaborates with partners to enhance awareness of children and parents by focussing on the following stakeholders:

Teachers and school authorities: Sexual violence in schools is a major area of concern. Schools should provide information on safety to children and online safety guidelines can be included in the curriculum. Schools also need to ensure that teachers are aware of the provisions of the Protection of Children from Sexual Offences Act.
Children: Child-led initiatives empower children to become advocates of change, voice their demands and take leadership in the change itself. Listening to children is also key as they can become vital stakeholders in their own safety. Decisionmakers, including parents and teachers, should listen to children so that their views can be incorporated into policies.
Civil society organizations, including faith-based and community-based organizations, can engage consistently with the communities and share with them important information around the need to protect children from any kind of violence and abuse and co-create local solutions.
Media, both traditional and digital, plays a vital role in disseminating information, mobilizing public opinion and building a discourse around the issue of child safety. Effective use of digital technology for creating further awareness on child safety is another platform that is being leveraged. We need to ensure that all children, every girl, and boy, no matter where they live or what their background is, benefit from the learning opportunities and connectivity that the digital world can provide. However, along with the benefits that digital technology provides, it has also put young people at risk of harm online, including abuse, exploitation, trafficking and cyberbullying.

Q. UNICEF has recently launched a report called ‘Every Child ALIVE’ focusing on the number of newborn deaths in the country. Has India made any progress in curbing the under-five mortality?

India has shown 66% reduction in the under-five mortality rate between 1990 and 2015, nearly meeting its Millennium Development Goal 4 target. This is much higher than the global decline of 55% during the same period. This progress has been due to a holistic approach to health programming for children. However, the progress has been slower for new-borns and has also been inequitable between boys and girls, with the under-five mortality rate for girls currently being 11% higher, at 41 per 1000 as against 37 per 1000 for boys.

Q. Why are more girls dying in India than boys?

Girls have the advantage of being biologically stronger, yet sadly they are extremely vulnerable socially. The discrimination begins even before they are born. Though the gender gap has started shrinking due to the fast decline of mortality for girls as compared to boys in the recent years, the gap still remains high in many states. The neglect of the girl child is a much broader issue and needs interventions beyond health to address the social norms and cultural practices that act as barriers to bridging the gender gap. It will require working at both the policy level for creating an enabling environment. And at the community level, to build awareness and bring emphasis to the value of the girl child. It will also need increased investments in the availability of gender-disaggregated data for more informed planning.

Q. Please share with us some details about the immunization campaign in India.

Immunisation is one of the most cost-effective public health interventions that currently averts an estimated 2 to 3 million child deaths globally every year. India has one of the largest immunization programmes in the world, in terms of a number of beneficiaries, geographical coverage, and quantities of vaccines used, with nearly 26 million new-borns targeted for immunization annually. However, despite this effort, only 65% of the children in India receive full immunization during the first year of their life.

This translates to 9 million children not fully protected against preventable diseases such as Diphtheria, Pertussis, Tetanus, Measles and Preventable pneumonia. To address this issue, Government of India, with the support of UNICEF, WHO, and other partners, has launched Mission Indradhanush to achieve 90% immunization coverage by the end of 2018. UNICEF is also supporting the government for the strategic communication activities on immunization, in order to create further awareness on the need for complete immunization as well as create a discourse on the value of vaccines.

Q. What is the Measles-Rubella Vaccine Campaign and why do we need it?

The Measles-Rubella (MR) vaccine has been introduced as part of the Universal Immunisation Programme (UIP) in India to protect children from two diseases, Measles and Rubella, which have high mortality and morbidity respectively. Measles is one of the leading causes of death among young children. It is a highly contagious disease caused by a virus and spreads by coughing and sneezing. It reduces the immunity of the child, making a child vulnerable to life-threatening complications such as pneumonia, diarrhea and infection in the brain. Hence, the burden of diarrhea and pneumonia can also be indirectly reduced by eliminating Measles.

Rubella, although a mild viral illness, can lead to serious consequences if pregnant women are infected during early pregnancy. It can result in miscarriages, stillbirths and a set of congenital anomalies in the foetus and new-borns known as Congenital Rubella Syndrome (CRS), which is a cause of public health concern. CRS is characterized by multiple defects, particularly affecting the eyes (glaucoma, cataract), ears (hearing loss), brain (microcephaly, mental retardation) and heart defects – many of which are lifelong disabilities, requiring treatment, surgeries and other expensive care throughout life. Hence, it is important to eliminate these diseases. The MR vaccine is provided free of cost under the campaign.

Q. What is the burden of Measles-Rubella in India and globally?

According to WHO estimates, an estimated 1.34 lakh deaths were caused globally by Measles in 2015. Measles and related complications killed an estimated 49,200 children in 2015 in India, contributing nearly 36% to the global figures. An estimated 84% of the global decline in Measles deaths from 2000 to 2016 was due to Measles vaccination. In 2010, an estimated 1.03 lakh children were born with Congenital Rubella Syndrome (CRS) globally, of which an estimated 40,000 children were born with CRS in India.

The Government of India has resolved to eliminate Measles and control Rubella. The Measles-Rubella (MR) vaccination campaign is an important step in that direction. Measles immunization directly contributes to the reduction of under-five child mortality. UNICEF is a key partner in the Ministry of Health and Family Welfare’s rollout of the ongoing Measles-Rubella Vaccination Campaign, which is now in its third phase and has vaccinated 7.7 crore children in 16 states till date (3 April 2018). The MR Campaign targets around 41 crore children, making it one of the largest ever immunization campaign of its kind. It aims to eliminate Measles and control Rubella by 2020. The vaccine has already been rolled out in several states and will soon be launched in Assam, Haryana, and Punjab.

Q. How safe is the Measles-Rubella vaccine?

The Measles-Rubella (MR) vaccine is a safe and cost-effective vaccine that has been available for the past 40 years. The presently used vaccine is a WHO-prequalified vaccine and is licensed by the Central Drugs Standard Control Organization of India. As many as 165 WHO member countries provide Measles second dose in their national immunization programme. The Rubella vaccine has been introduced in 159 countries. India, along with 10 other member countries of South East Asia region of WHO, has resolved to eliminate Measles and control Rubella and Congenital Rubella Syndrome (CRS) by 2020.

The surveillance of Adverse Events Following Immunisation (AEFI) is an integral part of the MR vaccination campaign. AEFI management kit is provided at all vaccination session sites including schools so that immediate response can be initiated following an AEFI.

The Government of India has recently amended AEFI management protocol. Now Adrenalin injection is part of each AEFI kit, which is life-saving in case of anaphylaxis. Both public and private sector medical practitioners and health workers are trained prior to MR campaign to handle such adverse events.

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Disruptive Technologies to Save Environment

InnoHEALTH Magazine — Wed, 08 Aug 2018 10:57:37 +0000

This is the age of Disruption, Sebastian Thrun, computer scientist says, and hits bull’s eye.

On 7th April 2018, a gush of fresh air of innovative ideas buffeted gently a modest wood-paneled auditorium in central Delhi as two enterprising innovators unveiled their ongoing disruptive technologies – based projects to depollute air and save thousands of litres of water as well as million units of electricity.d save thousands of litres of water as well as million units of electricity.
As audience clung to these innovators’ narratives in rapt attention, another eminent speaker Denny John dwelt at length on an absorbing theme of how to assess a healthcare technology for the larger interest of society. “Mine is a disruptive technology”, a lanky but hefty new age entrepreneur stole the limelight at the meet as he, in his baritone voice, said as an industry always have the tremendous appetite for future technologies and thereby revolutionize deliverable. He was Monish Bhandari of OptiMaser™ which works for disinfection of hospital wastes including many other things.
An engineer, who appeared firmly grounded and did not betray any sign of tremendous potential his “Shudh Vayu” and “Swasthgram” campaign holds for the society by cleaning tons of carbon in air by a simple filter on roofs of cars threw light on his disruptive innovation for combating menace of spiking pollution plaguing many cities.
The engineer Amit Bhatnagar said 920,000 children die under 5 years due to air pollution worldwide. In Delhi, it is 3000 in 365 days, almost 8 deaths per day, according to UNICEF report. Air Pollution inhaled during pregnancy can cross the placenta and affect the developing brain of a fetus.
Swasthgram and Shudh Vayu were founded by Mr. Amit Bhatnagar and his common friends. Mr. Amit Bhatnagar is an IITian turned into the social entrepreneur. He did his M.S. in Bio-Engineering from Penn State (US) in 2007 and B.Tech in Mechanical, Hollywood (USA). After relocating to India, he started envisioning his life’s goal and along with common friends established Swasthgram in 2012. He uses disruptive technology, innovated & specially designed to cater to all healthcare needs.
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The Saturday morning’s meet was a gathering of young innovators and industry experts in a conference hall in the national capital’s prestigious India International Centre to learn how to assess a healthcare technology for a beneficial outcome for the society.
Marking a step forward towards its promise of providing an encouraging platform to young innovators and innovative startup of the health sector, InnovatioCuris organized its fourth IC Innovators Club meeting that day. A date well was chosen, celebrating World Health Day, InnovatioCuris called on industry leaders to stand up to the pledges and join hands to take concrete steps to advance #HealthcareForAll.
We live in a culture where everyone’s opinion, views, and assessment of situations are twisted on social media if feared and hated by environmentalists (industry name say) and the public alike. Yet many a time, the scientific assessment of technology is remarkably different and tells altogether a different story. And we all know we become what we behold, we shape our tools and then our tools shape us. So, the assessment of any new tool or technology is very important. With this agenda, Denny John addressed the listeners which within no time compelled them to shed away their morning blues. Mr. John holds an external Ph.D. in HTA from Maastricht University, the Netherlands on the cost-effectiveness of vaccines related to infectious diseases in India. He is also an adjunct Scientist with ICMR-NIMS.
Being an Associate Editor for IJTAHC and Cost Effectiveness and Resource Allocation journals, he has also conducted various workshops on SR, EE and HTA training for over 300 members in Nepal, Ghana, and India. Under his literature, he has 10 peer-review publications on SR, EE and HTA, 2 book-chapters on Pharmacoeconomics, and 1 book on Systematic Reviews. Co-guiding 1 Masters and 2 Ph.D. students in HTA. He is a task force member on National Registry of Injuries in India. He is also a co-researcher on cost-effectiveness analysis of glaucoma screening in cataract camps.
The interventions used to promote health, to prevent, diagnose or treat acute or chronic diseases, or for rehabilitation which includes pharmaceuticals, devices, procedures and organizational systems used in healthcare, defines healthcare technology says, Mr. John. After he made listeners to understand what healthcare technology is, he guided them to understand what exactly HTA (Healthcare Technology Assessment) is.

A systematic evaluation of the properties of a health technology, addressing its direct and intended effects, as well as its indirect and unintended consequences, to inform decision-making is HTA. He explains, not only the assessment of the technology but also the evaluation and calculation of any input that goes into the delivery of the technology will be covered under HTA.
Narrating the story about BEMPU, a hypothermia monitoring device, he made a strong point that one should practice evidence-based approach, that stating evidence is very important not only while assessment of a technology but also in day-to-day healthy lifestyle habits. This gives context-specific inputs into the decision-making process at policy and organizational levels.
Evidence-based practice, Health economic evaluation, Policy and market analysis are the formation bricks of the architecture of HTA where Social aspects is also another brick in the wall catering its stakeholders, patients, health professionals, industry, third-party players and the government with trust and a good decision-making capability. A feedback from any stakeholder is always a good approach to perform analysis of your technology says, Mr. John. Especially when it comes to the customers, patients as (here) the case is, patient engagement is a huge buzz topic and knowing your customer is a great idea to improve. Taking feedback whether they are willing and are comfortable in using the technology and how they feel about the integration of it in their life could give you the taste of your own drug.
So, what is evidence-based practice? An evidence-based approach is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of an individual. Mr. John emphasizing on the usage and reporting of the evidence says, “wherein day-to-day life reporting of evidence is weak, the evidence should be taken based on the studies from multiple trials and research studies and not from a single study or trial”.
After stressing on the importance for stating the evidence he also explained the impact and need of economic evaluation analysis which addresses the additional health benefit gained from investment in a technology, such as the cost per additional Quality Adjusted Life Year (QALY) gained, by comparison of that technology to a different intervention or to no intervention.
Another important component of this valuable session was Budget Impact Analysis (BIA). Mr. John told that BIA addresses the affordability of the technology, such as the net annual financial cost of adopting the technology for a finite number of years.
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All this directly or indirectly contributes to the assessment of healthcare technology that one plans to adopt and present. In addition to this, he also explained briefly the ways a person can perform the economic evaluation of the technology under observation like cost-effective analysis, cost-benefit analysis or be it cost-utility analysis.
Mr. John also walked listeners through the schematic structure of Health Technology Assessment in India (HTAIn). Also, telling about how patients and consumers can be engaged in HTA, what all parameters are there on which they can evaluate the technology and how it would be beneficial for the same.
Mr. Monish Bhandari said post signing of the CITAR incubation MoU on 2nd May 2017, the entire aura of the association has fast-tracked with translating the lab research to commercial success, augmenting the brand value, potential & technical excellence of OptiMaserTM & it’s futuristic new Avatars.
OptiMaser™ potential in excess is exemplified by the fact that it can achieve systematic volumetric heating for disinfection with its mobility in any diverse industry environment. CITAR’s clinical ability to instantly establish protocols, validate clinical results has given OptiMaserTM the required thrust to develop dedicated cycles for medical waste disinfection; OT instrument disinfection; blood bag disinfection; dialyzer disinfection; linen disinfection; Bactec (BD) bottle disinfection and animal bedding (rice husk & corn cob) disinfection. He said that the technology being pursued by them, saves hundreds of liters of water and electricity consumption while disinfecting hospital wastes – many prestigious institutions are adopting the mode. The IC meeting came to an end after a very provocative question and answer session.

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Yoga Mojo Going Viral – Meditation in India

InnoHEALTH Magazine — Mon, 02 Jul 2018 08:07:09 +0000

For ages, we are taught to practice yoga and meditation in India and people do that at many places and in many forms but three years ago at India’s initiative, the United Nations recognized its significance and declared 21st June every year as the International Yoga Day.

In the first edition itself, the IYD had a roaring success worldwide and India created two world records. Since then, there is no going back in terms of celebrating the day with traditional gusto and ever vaulting spirits. Both President and Prime Minister led the nation on the day’s observation. To recap, the event’s increasing footprints, we decided to dedicate the current issue to IYD. And run a fleeting flashback of memories to revive afresh what happened in the previous three editions worldwide.

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In the same spirit, we are running a few items dedicated to the imperiled environment. As this year India hosts the International Environment Day with the theme to combat ever plaguing menace of plastic that had adversely impacted human lives and virtually choked waterways in variant degrees at many places.

India’s Environment, Forest and Climate Change Minister Dr. Harsh Vardhan, in an exclusive interview to InnoHEALTH Magazine, appealed to the people to give up single use of plastic and expressed confidence that a perceptible and measurable difference in the country will be brought about on plastic pollution and other environmental issues on the occasion of the World Environment Day 2018.

He is also the Science and Technology Minister. In March this year, Prime Minister Narendra Modi called for a “Fit India” movement, focusing on the benefits of yoga, in ‘Mann Ki Baat’. Mr. Rajyavardhan Rathore, the newly appointed Minister for Information and Broadcasting, seems to have taken a cue from the PM to take the initiative forward. He recently tweeted a video of himself doing push-ups with the hashtag #HumFitTohIndiaFit. Since then, the fitness campaign zoomed into a debate and many people accepted the challenge and started posting their videos.

International awards winner filmmaker Janet Tobia who has won laurels for her documentary “Unseen Enemy” flags major concerns over lurking threats on the environment. She was interviewed by our magazine to highlight her views on the Environment Day. The Emmy award winner said that her movie Unseen Enemy examines why in the 21st century. We are experiencing a rash of diseases that were once only outbreaks but have now become full-blown epidemics. She is precisely right on her perceptions and the fresh outbreak of Ebola in Congo vindicates her concerns.

Amid growing number of violent incidents against young children, we interacted with UNICEF’s India In-charge. Fresh from her experience in managing emergency situations, Dr. Yasmin Ali Haque handles the tsunami of problems during her current assignment. She has disclosed that the Indian government in collaboration with UNICEF is developing a comprehensive plan on digital safety for children. Digital literacy is key to ensuring that all boys and all girls stay informed, engaged and safe online. There is a need to galvanize ‘zero tolerance’ towards violence against children.

In the current issue, we are also carrying a number of other articles like forthcoming plans to jail those found guilty of poaching medical data of patients; medical commission bill facing rough weather; monkeys spa in Japan; how to breathe; IC meeting highlighting the era of disruptions; latest trends in healthcare and many more interesting stories of the health sector.

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First humanitarian medicine delivery drone

InnoHEALTH Magazine — Tue, 10 Apr 2018 05:56:34 +0000

First humanitarian drone put into use for medicine delivery at Malawi, Africa

If you are trapped in an inaccessible area during a natural crisis and need medicines, Midair Rescue Helicopters will instantly supply required medicine packets through a drone. The first humanitarian drone has been developed at IIT Kanpur in association with EndureAir.

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The Government of Malawi and UNICEF has launched an air corridor for potential humanitarian use of Unmanned Aerial Vehicles (UAVs), commonly known as ‘drones’. This is the first of its kind in Africa and unique in the world for the application of drone with a focus on humanitarian and developmental purpose.

The joint application of IIT Kanpur with EndureAir (sponsor and partner of IITK team for this activity) is approved by the Malawi Civil Aviation Authority (CAA) for first humanitarian drone testing activity.

The solution based on Autonomous Helicopter has been developed by the students of Aerospace Engineering Department: Mr. Nidhish Raj (PhD), Mr. Sagar- Setu (PhD), Mr. Ankur Duhoon (Research Engineer, IITK alumni) and Mr. JoydeepBhowmik (PhD) under the guidance of Prof. Abhishek and Prof. Mangal Kothari, Department of Aerospace Engineering.

The current Rotary Wing Unmanned Air Vehicle (RUAV) developed at IIT Kanpur is capable of lifting 3 kg of useful payload and fly for over 2 hours. The best range speed of the RUAV is 75 km/hr and the top speed can easily reach 120 km/hr. The UAV uses regular petrol as its fuel, which enables it to achieve better performance than battery powered drones.

The autopilot which is “brains” of the RUAV for fully autonomous operations has been fully developed by the students. The IIT Kanpur team would visit Malawi for trials and demonstration in February.

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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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