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Indian Health Care Sector

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Re: Indian Health Care Sector

Postby SSridhar » 29 Jun 2013 09:02

Apparently, there *is* a shortage of critical TB drugs in the country and the Ministry of Health and the Minister of Health, Ghulam Nabi Azad, were either unaware of the crisis or misled the country and the WHO (see the earlier post where the minister claimed there was no shortage). Only when the PMO intervenes, the MoH wakes up.

The MoH is not on top of the situation and has been slack in monitoring and taking immediate corrective actions. This is a dent in the fair name it earned otherwise on TB control so far.

Now, Multi-Drug-Resistant TB Drugs Stock Crisis Looms - Mohuya Chaudhuri, The Hindu
The uproar over the stock-out situation for anti-tuberculosis drugs has driven the government into action. It is learnt that following media reports, the Prime Minister's Office wrote a letter asking the Union Ministry of Health and Family Welfare (MoHFW) for clarification on the availability of drugs.

An emergency meeting was also called by the Central TB Division (CTD) to discuss the way forward to mitigate the crisis. Manufacturers of paediatric drugs, prolongation pouches and streptomycin have been identified and the ministry is hopeful of getting supplies to states by the end of July. States with a lower disease burden have been asked to transfer drugs to those with a higher burden facing extreme shortage of drugs.

Even though the current crisis is being addressed aggressively, a new one is raising its head. Stocks of second-line medicines like Kanamycin, an injectible drug used for treating multi-drug resistant (MDR) TB have dipped alarmingly. Currently, according to CTD officials, there is stock only for two and a half months. India is among the few countries with a high burden of MDR TB.

For patients, it is a race against time, especially paediatric and multidrug-resistant (MDR) TB cases. In Bihar, in almost every district, there are no drugs. A CTD official said that in two days Kanamycin, along with Pyridoxine (used to mitigate the side effects of Isoniazid), will run out. Against the requirement of 35,000 doses of Kanamycin, currently just 2500 doses remain. Likewise, there are only 4000 doses of Pyridoxine instead of the required 14,000.

The official said that patients who come for testing every day for MDR TB at the drug resistant TB testing facilities are not being informed of their status since there are no medicines for new patients to be treated. Day by day, the numbers are rising since many have not been able to take the correct course of treatment, he said. For the moment, the CTD has asked Rajasthan to transfer 10,000 doses of Kanamycin to Bihar but that is inadequate to deal with the current crisis.

Though the World Health Organisation (WHO) had maintained that there is no stock-out situation in India, in an internal briefing within the WHO on June 27 Dr. Nata Menabde, WHO representative, India, was apprised of the true status. {So, obviously, the MoH misled WHO too}

Delay in procurement

The briefing note stated that the shortage of drugs was due to procurement failures and delays at the level of the government of India. It also confirmed stock-out of paediatric doses, Rifampicin (the key drug to treat TB), streptomycin injection as well as diminishing stockpiles of Kanamycin injections and other first line drugs. The note also said that emergency procurement of paediatric drugs was delayed by six months and the orders had just been placed. {Callous, to use the most charitable word. If even 'emergency procuremen' of drugs, and that too for children, is delayed by six months, what can one say about the attitude of the officials, the file pushers ?}

As for Kanamycin, emergency procurement of over 400,000 vials, done with the support of the Geneva-based Global Drug Facility (GDF) through WHO’s intervention had not reached the country because of delays in processing orders, payments and the ministry not issuing the necessary customs duty clearance on time. {Absolutely pathetic}

Pressure building up

As a result, the consignment of Kanamycin was parked at a warehouse in China. It is learnt that the consignment was moved only this Monday. The pressure is now building up on the government. In a letter to Anshu Prakash, Joint Secretary, Health, the Independent Commission on Development and Health in India, states that the ground situation belies the ministry’s stand.

Its team has reported drug shortage in the field, especially paediatric drugs and that there is a risk of developing drug resistant TB in India. It has also asked the government to look into the factors that led to the crisis and take measures to correct the procurement process so that such a situation does not occur in the future.

(Mohuya Chaudhuri, former Senior Editor (Health) at NDTV, is an independent journalist. She also contributes to the British Medical Journal. This article has been written exclusively

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Re: Indian Health Care Sector

Postby Austin » 30 Jun 2013 19:06

India has 40 per cent of world's malnourished'

India constitutes 40 per cent of the world's malnourished population and the highest rate of underweight children due to improper implementation of government policies, a global health expert has said.

M G Venkatesh Mannar, president of Canada-based NGO Micronutrient Initiative, said India's condition despite being an emerging economy was bad in terms of health and nutrition as compared to other countries like Brazil, Nepal, Bangladesh and China.

"India has the highest rates of stunted growth, underweight and anaemia in children. And the most ironic part is that India has all the programs and policies required to handle the problem but then there is no proper implementation.

"Here it cuts across many ministries like the Ministry of Health, Women and Child Development, Education and Rural Development. Thus there are no champions of this problem and also no proper accountability," Mannar, who is one of the co-authors of the 2013 Lancet series on Maternal and Child Undernutrition, told PTI.

There is a lack of coordination between the state and Centre because of which there is a problem of implementation of the policies and programmes made in this regard, Mannar, who was also honoured with Canada's highest civilian award 'The Order of Canada', said.

"The astonishing part is that National Family Health Survey has not been done since 2005. We still look at the old figures and we are not aware whether we have progressed or regressed," he said.

He, however, praised some states like Maharashtra for achieving their targets. "If Maharashtra can do it, why other states can't?" he asked.

Appealing to the government to take action, he said India does not have to look outside for any help as it has all the policies and resources required to solve the problem.

"India just needs to get into action otherwise there will be severe consequences. What would all that economic growth mean if the new generation turns unproductive and perform below the world standards?" he asked. According to World's Children Report 2013 prepared by the UNICEF, India ranks 49th in the Under 5 Mortality rate whereas China, Brazil, Nepal and Bangladesh stand at 115, 107, 57 and 60 respectively.

The neo-natal mortality rate 2011 of India is 32 per 1,000 live births whereas it is 10 per 1,000 live births in Brazil and 26 per 1,000 live births in Bangladesh. India's infant mortality rate has reduced from 81 per 1,000 lives to 47 per 1,000 between 1990 and 2011 whereas it has reduced from 49 to 14 per 1,000 lives in Brazil during the same period.

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Re: Indian Health Care Sector

Postby Prem » 02 Jul 2013 01:07

http://www.huffingtonpost.com/2013/06/2 ... 13011.html

Obama Administration, Congress Intensify Opposition To Global Generic Drug Industry
WASHINGTON -- The Obama administration and members of Congress are pressing India to curb its generic medication industry. The move comes at the behest of U.S. pharmaceutical companies, which have drowned out warnings from public health experts that inexpensive drugs from India are essential to providing life-saving treatments around the world.Low-cost generics from India have dramatically lowered medical costs in developing countries and proved critical to global AIDS relief programs; about 98 percent of the drugs purchased by President George W. Bush's landmark PEPFAR AIDS relief program are generics from India. Before Indian companies rolled out generic versions priced at $1 a day, AIDS medication cost about $10,000 per person per year.
But India's generic industry has also cut into profits for Pfizer and other U.S. and European drug companies. In response, these companies have sought to impose aggressive patenting and intellectual property standards in India, measures that would grant the firms monopoly pricing power over new drugs and lock out generics producers.On Thursday, a House subcommittee held a hearing on international trade disputes with India that included testimony from American manufacturing and solar energy groups. Most of the event, however, was devoted to U.S. drug company Pfizer's complaints about Indian policies that have fostered the country's billion-dollar generics industry. The hearing followed Secretary of State John Kerry's trip to India earlier this week for the U.S.-India Strategic Dialogue, a major diplomatic mission.Last week, a bipartisan group of 170 House lawmakers sent a letter to Kerry and President Barack Obama raising objections to India's patent system. But at Thursday's hearing, few seemed well-versed on intellectual property or public health issues."I first learned of this issue just a few short weeks ago from Pfizer, my largest employer in my district," said Rep. Fred Upton (R-Mich.), before asking Pfizer Chief Intellectual Property Officer Roy Waldron if his company had talked to the Obama administration about its concerns.

"We have been speaking with [the Office of the U.S. Trade Representative] and the administration and we're very hopeful that this issue has been raised during Secretary Kerry's visit to India," Waldron replied.A State Department spokesperson told HuffPost that during his trip, Kerry "discussed a number of economic and trade issues with Indian officials, including ongoing issues in the pharmaceutical sector."Kerry's involvement represents an escalation in the Obama administration's opposition to India's generic drug policies. Following two recent landmark court decisions, the U.S. Patent and Trademark Office and the Office of the U.S. Trade Representative have been pressuring the Indian government on its patent standards.In January, India's Supreme Court rejected a patent on a Novartis leukemia drug called Gleevec (or Glivec), clearing the way for cheaper generic production. The active ingredient in Gleevec has been available for years, but Novartis filed for a patent on an updated version available in pill form. India's highest court turned down the application on the grounds that the delivery format did not constitute a legitimate innovation.
Gleevec is protected by multiple U.S. patents, and costs upwards of $75,000 a year domestically. In India, where annual per capita income is about $1,400, Novartis was charging about $31,000 a year for the medication. The generic version legalized by the court's decision costs around $2,100.Last year, India also permitted a generic manufacturer to produce a cheaper version of another cancer drug patented by Bayer AG. Bayer was charging $5,000 a month for the drug, while only servicing about 2 percent of the population that needed it. The generic version was priced at $157 a month.By securing secondary patents, as Novartis tried to do with Gleevec, drug companies can effectively extend monopolies on their medicines beyond the standard 20-year window required by World Trade Organization treaties. The practice is known as "evergreening," and is frowned upon by the World Health Organization.At Thursday's hearing, Rep. Jerry McNerny (D-Calif.) appeared more concerned than other lawmakers about the public health consequences of altering India's existing patent system. He asked Rohit Malpani of the international medical aid group Doctors Without Borders to elaborate on problems that arise from evergreening.Rep. Henry Waxman (D-Calif.) also extolled the importance of access to inexpensive medications for PEPFAR, which has seen its budget cut in recent years.Otherwise, lawmakers appeared receptive to Waldron's contention that U.S.-style intellectual property policies in India will help develop a more robust and innovative medical system there. Waldron also said such practices would lead to the creation of more American jobs, pointing to a study from the U.S. Department of Commerce that was also cited in last week's letter from lawmakers.
That study has been widely ridiculed for overstating the impact of intellectual property protections on jobs, claiming that "IP-intensive" industries are responsible for nearly 20 percent of all American jobs. Yet the pharmaceutical industry, which is largely comprised of firms dependent on government copyright and patent protections, accounts for a little less than 300,000 jobs, according to the report.
The U.S. has attacked the global generic drug industry before. President Bill Clinton adopted policies during his presidency that were hostile toward the introduction of generic AIDS medications in Africa, relenting only when activists disrupted campaign events over the issue. Clinton later came to regret his administration's position and has been very active on international AIDS relief efforts through the Clinton Global Initiative.

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Re: Indian Health Care Sector

Postby Neshant » 04 Jul 2013 00:15

Not sure what would go into the box but something of this sort might help reduce the high infant mortality rates in India. Perhaps fewer cold weather clothing and more medical and nutritional suppliments.

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For 75 years, Finland's expectant mothers have been given a box by the state. It's like a starter kit of clothes, sheets and toys that can even be used as a bed. And some say it helped Finland achieve one of the world's lowest infant mortality rates.

It's a tradition that dates back to the 1930s and it's designed to give all children in Finland, no matter what background they're from, an equal start in life.

The maternity package - a gift from the government - is available to all expectant mothers.

It contains bodysuits, a sleeping bag, outdoor gear, bathing products for the baby, as well as nappies, bedding and a small mattress.

With the mattress in the bottom, the box becomes a baby's first bed. Many children, from all social backgrounds, have their first naps within the safety of the box's four cardboard walls.

Mothers have a choice between taking the box, or a cash grant, currently set at 140 euros, but 95% opt for the box as it's worth much more.

The tradition dates back to 1938. To begin with, the scheme was only available to families on low incomes, but that changed in 1949.

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"Not only was it offered to all mothers-to-be but new legislation meant in order to get the grant, or maternity box, they had to visit a doctor or municipal pre-natal clinic before their fourth month of pregnancy," says Heidi Liesivesi, who works at Kela - the Social Insurance Institution of Finland.

So the box provided mothers with what they needed to look after their baby, but it also helped steer pregnant women into the arms of the doctors and nurses of Finland's nascent welfare state.

In the 1930s Finland was a poor country and infant mortality was high - 65 out of 1,000 babies died. But the figures improved rapidly in the decades that followed.

Mika Gissler, a professor at the National Institute for Health and Welfare in Helsinki, gives several reasons for this - the maternity box and pre-natal care for all women in the 1940s, followed in the 60s by a national health insurance system and the central hospital network.

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Re: Indian Health Care Sector

Postby Murugan » 11 Jul 2013 14:59

Fight Malnutrition: distribute one papaya tree, one drumstick & one chickoo tree to every home. this will eradicate malnutrition and will increase the green cover. Encourage cash crops & increase more wet land ..I hope this will be executed in the large scale across the India.. You are revolution yourself let us have green revolution rolling..

(FB Post by one Mr Sachin Shetty)

It is true, Drum Stick trees leaves and pods are full of various nutrient.

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Re: Indian Health Care Sector

Postby Austin » 13 Jul 2013 16:54

Unequal India
THE SHAM OF HEALTHCARE

So what is the way out of the health crisis which is perhaps the biggest adversity facing India today? The problems are large, but rather than being overwhelmed by their enormity, we should identify the ways and means of overcoming this adversity, drawing both on the analyses of the factors that have contributed to this crisis, and also-closely related to that investigation-on the lessons that have emerged from the experiences of other developing countries which have dealt with these problems much better than India has. There is also much to learn from the better performance of those Indian states (Kerala and Tamil Nadu in particular) which have taken care of the health of the people a lot better than the rest of India. As far as the rest of the world is concerned, the countries that offer immediate lessons for India include-most importantly-China, but also Brazil, Mexico and Thailand, among others.

Perhaps the first-and the most crucial-thing to appreciate is the importance of the commitment to universal coverage for all in a comprehensive vision of health care for the country as a whole. Thailand, Brazil and Mexico have got there in recent years, and transformed the reach of health care for their people. China's experience is particularly interesting, since it attempted, first, to deny the necessity of this commitment when the economic reforms first occurred, in 1979, and by reversing the earlier universalism, China paid a heavy price for this denial in terms of the progress of longevity and general health. China eventually realized the error in this denial and, from 2004, started moving rapidly back to universal commitment (China is already 95 per cent there), reaping as it is sowing. And contrary to what we often hear from alleged admirers of China who want India to follow China without being quite sure of what it is that the Chinese do, China does not leave the coverage of health in the hands of private health insurance-the state is the major player to ensure this. These experiences are, as we have already discussed, entirely in line with what we would expect on grounds of economic reasoning, particularly because of (1) the 'public goods' character of the health of people, (2) the role of asymmetric information, and (3) the impact of inequality on the achievement of general health in a community and a nation.

The commitment to universal health coverage would require a major transformation in Indian health care in at least two respects. The first is to stop believing, against all empirical evidence, that India's transition from poor health to good health could be easily achieved through private health care and insurance. This recognition does not, of course, imply that there is no role at all for the private sector in health care. Most health care systems in the world do leave room for private provision in one way or another, and there is no compelling reason for India to dispense with it. Nor can health planning in India ignore the accountability issues and other challenges that affect the operation of the public sector-including the public provision of health care. Nevertheless, the overarching objective of ensuring access to health services and other requirements of good health 'to all members of the community irrespective of their ability to pay' (as the Bhore Committee aptly stated the core principle of universal health coverage many years ago) is intrinsically a public responsibility. Further, given the limitations of market arrangements and of private insurance in the field of health care, public provision of health services has an important foundational role to play in the realization of universal health coverage.

Following on this, the second respect in which the proposed approach demands a change in India lies in the need to go 'back to basics' as far as public provision of health care services-both of a preventive and curative kind-is concerned, with a renewed focus on primary health centres, village level health workers, preventive health measures, and other means of ensuring timely health care on a regular basis. While RSBY (the newly established scheme of subsidized health insurance for poor households) is a humane programme and much better than leaving the poor to die or suffer from neglected health care and unaffordable intervention, better results can be achieved at far less cost through early and regular health care for all (supplemented by providing expensive intervention if and when it is needed despite early and more systematic medical care for all).

The need for public involvement is particularly strong in a range of activities aimed at preventing rather than curing disease, such as immunization, sanitation, public hygiene, waste disposal, disease surveillance, vector control, health education, food safety regulation, and so on (what is technically known as 'public health').

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Re: Indian Health Care Sector

Postby Prem » 15 Jul 2013 08:46

As Mystery Illness Stalks Its Young, India Intensifies Search for a Killer
http://www.nytimes.com/2013/07/14/world ... .html?_r=0

MUZAFFARPUR, India — The children begin arriving every year in mid-May, brought to an overburdened hospital here in one of India’s most impoverished areas by their panic-stricken mothers. Seemingly healthy hours earlier, most have lapsed into a coma, punctuated by convulsions.Doctors work to calm the convulsions and keep the children hydrated, but then have to watch helplessly along with the anguished parents as a third of their young patients die, often within hours. Then, as suddenly as it started, the mysterious outbreak stops with the onset of the monsoon rains this month. No one knows why.The mud-and-bamboo huts in this part of India cradle more dying children than anywhere in the world, with diarrhea and malnutrition long ranking as the region’s great scourges. But now, this unknown killer is stalking the very young.Although public health statistics are unreliable here, the disease is believed to infect tens of thousands of people a year and kill thousands.All doctors know is that the illness is a form of brain swelling, or encephalitis, but that is a huge category, covering a wide spectrum of diseases. Doctors have tested for known causes of brain swelling, including meningitis and Japanese encephalitis, but the tests almost always come back negative. India’s top health officials say the disease, known officially as acute encephalitis syndrome, has them stumped.“This outbreak happens every year, and we have not been able to identify the cause or link even a single factor responsible,” Dr. L. S. Chauhan, the director of the National Center for Disease Control in India, said in an interview.Dr. Chauhan hopes to change that. With help from the Centers for Disease Control and Prevention in Atlanta, he started a program this year to train an elite cadre of disease sleuths, part of a recently organized Epidemic Intelligence Service in India that he hopes will eventually undertake the investigations of India’s estimated 1,500 epidemics.But the outbreak in Muzaffarpur is slowly spreading to neighboring areas, and Dr. Chauhan has thrown everything he can at it, assigning all seven of his trainees — each already an accomplished physician. Experts from the C.D.C. are advising them, and their work is being closely followed by concerned officials in the United States.The first reports of this mysterious illness date to 1995, when nearly 1,000 children were sickened and 300 died in Muzaffarpur’s three hospitals. Smaller epidemics have followed almost every year since.Officials say they do not know whether the illness began in 1995 or had simply gone unnoticed before. Not only has it spread to nearby areas, but researchers have also recently found similar cases in neighboring Nepal. Some outbreaks in India have gone unreported because officials suppressed any mention for fear of prompting panic or criticism.“India has a huge problem with encephalitis,” said Dr. Rajesh Pandey, one of the epidemiologists camped out in Muzaffarpur, “and it’s not something almost anyone knows about.”“This is a real mystery,” Dr. Thomas R. Frieden, the C.D.C. director, said in a telephone interview. “We’re not sure we’ll be able to solve it, but at least we can unleash the best epidemiological tools we have to try to answer the question.”Dr. Chauhan’s team has been given a rustic guesthouse next to a hospital here. There is no air-conditioning, the beds sag and the electricity is fitful. But there is an urgency to the doctors’ work. They gather almost every night in a small dining room to update crude posters with information about each case and debate their theories. A new virus, an old bacteria, litchis, alcoholic tree sap, heat, pesticides, rats, bats and sand flies are among the suspected causes.

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Re: Indian Health Care Sector

Postby SSridhar » 16 Jul 2013 17:03

Country-wide war on adolescent anaemia - Aarti Dhar, The Hindu
In a major initiative to address adolescent anaemia, the government is launching a Weekly Iron Folic Acid Supplementation (WIFS) Programme from Karnataka from Wednesday.

Speaking to reporters here on Monday, Anuradha Gupta, Mission Director, National Rural Health Mission, said supervised Iron-Folic Acid (IFA) would be administered, and sessions would be held in schools and Anganwadi centres to counsel adolescents and their care-givers on nutrition and related health issues.

WIFS, which is already being implemented in some States for pregnant and lactating mothers, will cover the population in the age group 10-19. The programme, to be implemented across the country in both rural and urban areas, will cover 13 crore adolescents — 6 crore girls and 7 crore boys — enrolled in classes VI-XII in government and aided schools, and 7 crore out-of-school adolescent girls.

Almost 50 per cent of nutritional deficiency-related anaemia is Iron Deficiency Anaemia which is a result of under-nutrition and poor dietary intake of iron, says Ms. Gupta. India has a high prevalence of adolescent anaemia with about 56 per cent girls and 30 per cent boys suffering from the condition. It is the underlying cause of 20-40 per cent maternal deaths.

Risks

Anaemia in adolescents results in poor physical growth, reduced school performance and diminished concentration in daily tasks. In adolescent girls, it enhances the risk of preterm delivery and of their having low birthweight babies who are not likely to reach the age of one. Young women in the age group 15-24 account for about one-third of all maternal deaths.

The key features of WIFS include administering supervised Weekly IFA supplements of 100 mg elemental iron and 500 mg folic acid; screening of target groups for moderate/severe anaemia and referring these cases to an appropriate health facility; bi-annual de-worming (Albendazole 400 mg), six months apart, for control of helminth (parasitic worm) infestation, and imparting information on improving dietary intake and prevention of intestinal worm infestation.

The Health and Family Welfare Ministry has suggested to the States that a day in a week, preferably Monday, be earmarked for providing IFA tablets to adolescents.


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Re: Indian Health Care Sector

Postby SSridhar » 22 Jul 2013 15:09

Train doctors on brain-death protocol - The Hindu
Chennai: The city’s performance in the cadaver transplant programme is improving but there is plenty of room for improvement, say experts.

Under the programme, vital organs are harvested from patients who have been declared brain dead, after obtaining permission from their families, and transplanted on to those in need. Four city government hospitals and 21 private hospitals are currently part of the programme, run by the State government. Two hospitals – Rajiv Gandhi Government General Hospital and Apollo Hospitals – are the top two contributors of donors. Since 2008, there have been 285 donors from Chennai, resulting in 513 kidneys, 255 livers, 57 hearts and 22 lungs being donated, according to the programme’s officials.

However, certification of brain death is still relatively low among hospitals owing to multiple factors, the primary one being a lack of awareness about the protocol among medical professionals.

For instance, last year, a city hospital accounted for 48 brain deaths, but this translated into only one donor.

“Studies show that at least 3 to 6 per cent of all deaths in any large hospital are brain deaths. At present, hospitals only certify brain death intermittently. With more certification, there can be more organs available,” said Sunil Shroff, managing trustee, MOHAN Foundation, an organisation that coordination organ donations and transplantations.

“The government should conduct an audit and ask hospitals to submit monthly data on their brain deaths,” Dr. Shroff said.

The State, as yet, has no comprehensive data on the number of brain deaths that occur per year or their cause. According to the programme’s officials though, 83 per cent of the brain deaths reported over four years were due to road traffic accidents or head injuries.

Some hospitals, experts said, just do not have the expertise to harvest organs, the facilities to maintain cadavers or transplant coordinators to talk to grieving families.

So what goes into certifying a brain death? A senior neurologist at a government hospital explained, “The patient should be unconscious and on ventilator support. The hospital should know the reason for the brain death. A neurologist should certify that the person is brain dead and a second doctor should confirm this after six hours. Then, the duo should do a confirmation test.” “Even though there are clear-cut protocols for certifying brain death, there is a lack of awareness about them. Medical professionals need to be educated about the protocol,” said K. Sridhar, director of neurosciences at Global Hospitals.

C.E. Karunakaran, trustee of the National Network for Organ Sharing, said doctors should be motivated to certify brain deaths.

J. Amalorpavanathan, State convenor of the cadaver transplant programme said they were planning to reach out to two or three major hospitals to promote certification. “The potential for cadaver donation is 10 times higher than our current level. We need to simplify the protocol and explain the medico-legal process to hospitals,” he said.


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Re: Indian Health Care Sector

Postby SwamyG » 27 Jul 2013 06:27

Jhujar wrote:As Mystery Illness Stalks Its Young, India Intensifies Search for a Killer
http://www.nytimes.com/2013/07/14/world ... .html?_r=0

It is heart wrenching to see little kids in helpless condition on beds or parents arms. Is the health infrastructure just overwhelmed, or is the infrastructure not good enough? Nothing wrong in seeking help from outside, but it shows India needs trained medical professionals at various levels. And also it appears 'prevention' of these outbreaks needs to be studied more.

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Re: Indian Health Care Sector

Postby Prem » 29 Jul 2013 23:45

Heart Surgery in India for $1,583 Costs $106,385 in U.S.

http://www.bloomberg.com/news/2013-07-2 ... -u-s-.html

Devi Shetty is obsessed with making heart surgery affordable for millions of Indians. On his office desk are photographs of two of his heroes: Mother Teresa and Mahatma Gandhi.Enlarge image Heart Surgery in India for $1,583 Costs $106,385 in U.S. Open heart surgery is carried out on a baby at the Narayana Hrudayalaya Institute of Cardiac Sciences in Bangalore, India. Photographer: Enlarge image Heart Surgery in India for $1,583 Costs $106,385 in U.S.
A man washes clothes while a child bathes at a communal water pump in the village of Paltupur, Uttar Pradesh. Cutting medical costs is especially vital in India, where more than two-thirds of the population lives on less than $2 a day and 86 percent of health care is paid out of pocket by individuals. Photographer: Sanjit ...
Shetty is not a public health official motivated by charity. He’s a heart surgeon turned businessman who has started a chain of 21 medical centers around India. By trimming costs with such measures as buying cheaper scrubs and spurning air-conditioning, he has cut the price of artery-clearing coronary bypass surgery to 95,000 rupees ($1,583), half of what it was 20 years ago, and wants to get the price down to $800 within a decade. The same procedure costs $106,385 at Ohio’s Cleveland Clinic, according to data from the U.S. Centers for Medicare & Medicaid Services.
““Cutting costs is especially vital in India, where more than two-thirds of the population lives on less than $2 a day and 86 percent of health care is paid out of pocket by individuals. A recent study by the Public Health Foundation of India and the London School of Hygiene & Tropical Medicine found that in India non-communicable ailments such as heart disease are now more common among the poor than the rich.One in four people there die of a heart attack and per-capita health spending is less than $60 a year. Yet the country performs only 100,000 to 120,000 heart surgeries each year, well short of the 2 million Shetty estimates are needed. The mortality rate from coronary artery disease among South Asians is two to three times higher than that of Caucasians, according to a study published in 2008 in the journal Vascular Health and Risk Management.Dietary Patterns
“There has been fast urbanization in India that’s brought with it a change in dietary patterns and lifestyle,” said Usha Shrivastava, head of public health at the National Diabetes, Obesity and Cholesterol Foundation. “It’s leading to this huge jump in cardiovascular disease.”
The average age for a first heart attack in India, Pakistan and other South Asian nations was 53 years, compared with 58.8 years in countries outside the region, according to a study published in 2007 in the Journal of the American Medical Association.The biggest impediment for heart surgery in India is accessibility. Shetty aims to bridge that by building hospitals outside India’s main cities. He said he plans to add 30,000 beds over the next decade to the 6,000 the hospital chain has currently, and has identified 100 towns with populations of 500,000 to 1 million that have no heart hospital.A 300-bed, pre-fabricated, single-story hospital in the city of Mysore cost $6 million and took six months for construction company Larsen & Toubro Ltd. to build, Shetty said. Only the hospital’s operating theaters and intensive-care units are air-conditioned, to reduce energy costs.
Changing ProceduresOne of the ways in which Shetty is able to keep his prices low is by cutting out unnecessary pre-op testing, he said.Urine samples that were once routine before surgery were eliminated when it was found that only a handful of cases tested positive for harmful bacteria. The chain uses web-based computer software to run logistics, rather than licensing or building expensive new systems for each hospital.
When Shetty couldn’t convince a European manufacturer to bring down the price of its disposable surgical gowns and drapes to a level affordable for his hospitals, he convinced a group of young entrepreneurs in Bangalore to make them so he could buy them 60 percent cheaper.In the future, Shetty sees costs coming down further as more Asian electronics companies enter the market for CT scanners, MRIs and catheterization labs -- bringing down prices. As India trains more diploma holders in specialties such as anesthesiology, gynecology, ophthalmology and radiology, Narayana will be able to hire from a larger, less expensive talent pool.One positive unforeseen outcome may be that many of the cost-saving approaches could be duplicated in developed economies, especially in the U.S. under health reform.“Global health-care costs are rising rapidly and as countries move toward universal health coverage, they will have to face the challenge of providing health care at a fairly affordable cost,” said the World Heart Federation’s Reddy, a New Delhi-based cardiologist who is also president of the Public Health Foundation of India.

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Re: Indian Health Care Sector

Postby SSridhar » 30 Jul 2013 10:45

Mumbai Child becomes Fourth Indian to Get Polio from Vaccine - The Hindu
A nine-month-old boy from Navi Mumbai has tested positive for Vaccine- Derived Poliovirus (VDPV) type 2 and is now on ventilator at BJ Wadia Hospital in Parel. This is the fourth such case recorded in the country this year.

“When he arrived, he didn’t have any power in all the four limbs. Now, he is showing signs of improvement. There is flickering and muscle contraction in his legs,” said the director of the Directorate of Health Services, Dr. Satish Pawar.

Arsh Singh, born in Muzaffarpur, Bihar, was brought to Mumbai by his mother when he was two months old. Since then, he has been orally vaccinated for polio five times. “There seems to be a problem with his immunity, which we are examining at the moment. In normal children, the polio virus in the intestines completely dies after about 200-300 rounds of replication. But in this child’s case, due to low immunity, the virus seems to have become virulent, resulting in polio,” said Dr. Pawar.

A Polio Surveillance Team visited the Ilthanpada area in Navi Mumbai where the child lives. The area has 95 per cent polio vaccination coverage, according to municipal records. The team has taken stool samples of all the family members, including Arsh’s older brother.

Meanwhile, the State Health Department has asked the Navi Mumbai Municipal Corporation to follow a protocol. “There are about 450 children in the Ilthanpada area and they will be thoroughly examined. A polio drive will be undertaken in Navi Mumbai and if there are homes that had not administered polio drops, they will be asked to do so,” Dr. Pawar said. The sewage system and other sanitary conditions in the area would also be checked.

The earlier three cases were from Orissa, Pudicherry and Maharashtra. In 2012, a VDPV case was recorded from West Bengal. Going by the past records, circulating VDPVs have been rapidly stopped with 2-3 rounds of high-quality immunisation campaigns. Health experts said the solution lay in immunising a child several times with the oral vaccine to stop polio transmission, regardless of the origin of the virus.

The time has come to shift to Injected Polio Vaccine, as this does not cause the disease. Even as India has become polio-free, the need of the hour is for the government to come up with a comprehensive programme where even VDPVs don’t occur,” said Dr. Nitin Shah, paediatrician from PD Hinduja Hospital.

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Re: Indian Health Care Sector

Postby SSridhar » 17 Aug 2013 09:40

Panel to study pentavalent vaccine's safety - The Hindu
In the wake of 21 infants dying after receiving Pentavalent vaccine in the country, the government will conduct a study to ascertain its safety.

According to informed sources, the national-level Adverse Events Following Immunisation (AEFI) Committee of the Ministry of Health and Family Welfare is in the process of holding a study on safety of the vaccine, which was introduced in India in 2011, as well as to ascertain the background under which the deaths were reported within 72 hours of vaccination.

Safety

“A major study is to be launched soon on the safety and effectiveness of Pentavalent vaccine and to go into background of these deaths,” committee chairman N.K. Arora said.

So far, 90 lakh doses of Pentavalent have been administered to children in eight States.

While the vaccine was introduced first in Kerala and Tamil Nadu in December 2011, it was introduced in Gujarat, Goa, Haryana, Karnataka, Puducherry and J&K since then.

The vaccine protects children against five deadly childhood diseases — DPT (Diphtheria, Pertussis and Tetanus), Hepatitis B and Haemophilus influenza type B (HiB).

The proposed study will be conducted with the help of some other agencies and the WHO will also be involved in it.

Infants of 6 to 18 weeks will be followed under to ascertain the overall safety of the vaccine. While Kerala has reported the maximum of 15 such deaths, Tamil Nadu has reported a few, while one death each has been reported from Haryana, Jammu and Kashmir and Chandigarh.

Maintaining that Pentavalent has been a “safe and effective” vaccine, with the poor and urban people being its biggest beneficiaries, Mr. Arora said a study to ascertain the causes of infant deaths occurred so far and to find out its overall safety was required to be undertaken before other vaccines were introduced in the country.

Infants

The committee had investigated the deaths and found them unrelated to the vaccine, but need has been felt to track infants who got the shots so that exact causes of death could be ascertained.

The Global Alliance for Vaccine Initiatives (GAVI) is providing the vaccine in India under the WHO initiative.

Some neighbouring countries like Bhutan and Sri Lanka and Vietnam had suspended the use of Pentavalent after concerns over its safety, but re-introduced it later, say the sources. — PTI

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Re: Indian Health Care Sector

Postby vera_k » 27 Sep 2013 00:13

SRS for 2012 has been uploaded. Quite a bit of progress in some states, but stagnant indicators in other states.

Kerala's fallen behind Sri Lanka.
TN has caught up with Nicaragua.
Delhi's on par with Guatamela.
Gujarat level with Iraq.

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Re: Indian Health Care Sector

Postby panduranghari » 29 Sep 2013 13:37

Jhujar wrote:Heart Surgery in India for $1,583 Costs $106,385 in U.S.
Devi Shetty is obsessed with making heart surgery affordable for millions of Indians.
According to data from the U.S. Centers for Medicare & Medicaid Services.
““Cutting costs is especially vital in India, where more than two-thirds of the population lives on less than $2 a day and 86 percent of health care is paid out of pocket by individuals. A recent study by the Public Health Foundation of India and the London School of Hygiene & Tropical Medicine found that in India non-communicable ailments such as heart disease are now more common among the poor than the rich.


link

Problem is not money, it's manpower
• India is short of at least 1 million doctors, 2 million nurses
• WHO estimates global shortage of 4 million health workers.
• Acute shortage of specialists. US>India
• Nephrologists.

Crisis in nursing
• India is short of at least 2 million nurses.
• Admission to nursing schools have come down by 50% in India.
• Nursing is a dead end job with no opportunity for carrier progression in India.
• Nurses are not empowered even to give an injection.

India needs 500 new medical schools
• If India adds 100 new medical schools a year for the next 5 yrs we will adequate number of doctors by 2025.
• It costs about $40 million to build one medical school.
• Medical education is very expensive.


Why is it so expensive to build a medical school in India ?
• Existing large hospitals cannot become teaching institutes.
• A new campus to be created on 25 acres of land with hospital, academic block, hostel, auditorium, playground built according to specifications.
• Only not-for-profits can run educational institutions.
• Teacher retirement age of 60, no part-time teachers recognised.
• Archaic curricula requires 250 teachers for 100 students while GMC requires 40 teachers.

Intent and policy mismatch
• Government spends 1% of GDP on Healthcare.
• 80% of the national expenditure on health is borne out of pocket.
• 47% of the rural, 37% of the urban population borrow money or sell assets to pay for health care.
• Health care costs are the most common cause of rural indebtedness.
• Shortage of 3 million beds.
•No standard PPP.
Last edited by panduranghari on 29 Sep 2013 13:42, edited 1 time in total.

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Re: Indian Health Care Sector

Postby panduranghari » 29 Sep 2013 13:40

I am certain that with economic downturn in the west, there will be many Indian and western doctors seeking employment in India. Hopefully there will be some policy that will use the services of these returning doctors for the benefit of the desh. Modi ji should approach Devi Shetty for help in this regard.

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Re: Indian Health Care Sector

Postby nawabs » 10 Oct 2013 23:24

Scientists stumble upon chemical that prevents death of brain tissue

http://www.livemint.com/Politics/ZV9Cen ... -brai.html
Researchers at the Medical Research Council’s (MRC) Toxicology Unit at the University of Leicester have established, by tests on mice, that all brain cell deaths from prion disease—a family of rare progressive neurodegenerative disorders—can be prevented.

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Re: Indian Health Care Sector

Postby SSridhar » 12 Oct 2013 03:46

Number of ew cases of leprosy in India 'disturbing' - Business Line
People affected by leprosy continue to lose their jobs, families, social standing and dignity, due largely to the deep-rooted stigma attached to the disease despite it being completely curable.

The number of people affected by the disease in India was huge and the number of new cases every year was “disturbing”, said Secretary, Health & Family Welfare, Keshav Desiraju. He was addressing the launch function of the HEAL (Hire, Educate, Accept Leprosy-affected) India campaign here {New Delhi} on Thursday.

The campaign, launched by the Leprosy Mission Trust India, aims to clear misconceptions around the disease. India accounts for 58 per cent of new leprosy cases worldwide.

Desiraju said healing, inclusion and dignity were the watchwords for this campaign. “The Government would do whatever it took to ensure treatment, but we need the cooperation and participation of everyone for shedding the fear of leprosy.”

The campaign plans to reach out to over a million people by bringing together corporates, Governments, entrepreneurs, children, schools, celebrities, non-Government organisations and people affected by leprosy.

It also plans to open up avenues for employment of people affected by leprosy by helping them build their skills, connecting them to job opportunities through a corporate charter with industry bodies, the trust said.

To spread awareness, HEAL India plans to use celebrities, television shows and music to urge India to treat people affected by leprosy with dignity and respect. A HEAL anthem will also be created with popular musicians and celebrities to highlight the issue.

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Re: Indian Health Care Sector

Postby Prem » 06 Nov 2013 05:28

http://www.medicalnewstoday.com/releases/268283.php
Project in India could save the eyesight of thousands

Scientists from the University of Sheffield have partnered with a team in India for a project which could save the eyesight of thousands of people living in the South Asian country. As in most developing countries, corneal infection in India is a serious problem and many patients are diagnosed too late to save their vision. Along with his colleagues; Professor Ian Douglas, from the University's School of Clinical Dentistry and Professor Sheila MacNeil, from the Department of Materials Science and Engineering, the trio have designed polymers which - on recognition of bacteria - collapse around it trapping the bacteria in place and then allowing it to be removed. The process has been used on eyes allowing bacteria to be removed from the cornea. Corneal infection is either caused by bacteria or fungi. The new research will now extend the group's work to also recognise fungi. It will work by adding dyes which change colour depending on what is causing the infection so doctors know what treatment to prescribe. Professor Rimmer added: "Thousands of patients lose their eyes because of late diagnosis in India and the developing world. "The issues are especially acute in rural areas where access to primary eye care is limited. Lack of facilities also means that when treatment is commenced early clinicians are forced to simply use multiple mixtures of drugs, such as antibiotics and of course this increases the rate at which pathogens develop resistance.
"Once fully developed our system should provide a cost-effective and rapid way of identifying the two classes of bacterial infection or fungal infections. "The system can be applied without laboratory facilities and results would be obtained within an hour, allowing medical staff to quickly provide the right therapy in the field." It is hoped the three year project will ultimately lead to a huge reduction in patients losing their eyesight. , led by Professor Sheila MacNeil in the UK and Dr Virender Sangwan in India, is developing a biodegradable synthetic membrane for the delivery of stem cell therapy to the eyes of patients who are blinded by damage to the cornea as a result of chemical injury or burns.

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Re: Indian Health Care Sector

Postby A Sharma » 25 Nov 2013 04:56


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Re: Indian Health Care Sector

Postby Austin » 09 Dec 2013 09:37

What Govts Spend On Health Care

At 60%, India has one of the highest out-of-pocket health care expenditures. Besides, the country has only 6.49 doctors per 10,000 people, lower than even Pakistan, which spends just 2.5% of its GDP on health care.


Image

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Re: Indian Health Care Sector

Postby SSridhar » 13 Jan 2014 07:44

India Polio-free for Third Straight Year - The Hindu
India has a reason to smile. On Monday, it completes three years without reporting any case of polio.

It is only the second time in the history that a disease is being eliminated in India through immunisation after small pox in May 1980.

However, officially the World Health Organisation (WHO) will certify India as polio-free on February 11 after the last of random samples picked up would be tested.

India’s being declared polio-free is particularly important because it was the only country in the South East Asian region with polio cases.

Once India is declared polio-free, the entire WHO region would also become polio free. {Obviously, WHO includes India as part of South East Asia} The WHO on February 24, 2012 removed India from the list of countries with active endemic wild polio transmission.

India carried a large burden of polio disease but has made impressive progress in the past 35 months.

The number of polio cases came down from 741 in 2009 to 42 in 2010 and just one in 2011 – from West Bengal.

No polio case has been reported in the country since then. {There are some states in India which have not reported polio for nearly two decades}

India won the war against polio through intense Pulse Polio Immunisation under the Global Polio Eradication Initiative in 1988 under which over 17 crore children were vaccinated in each round of vaccination with the help of 24 lakh vaccinators.

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Re: Indian Health Care Sector

Postby SSridhar » 13 Jan 2014 12:18

Vaccines can change children's future - Nata Menabde, Business Line
A single medical discovery has changed the future of children. Vaccination is a powerful and cost-effective weapon against disabling and life-threatening diseases. In India, nearly two million children still die from preventable diseases such as pneumonia, diarrhoea, malnutrition and birth complications.

Haemophilus influenzae type b (Hib) is a major cause of bacterial meningitis while pneumonia caused by Hib and Streptococcus pneumoniae (S. pneumoniae or pneumococcus) is also a threat to children’s health worldwide.

Rotavirus-related diarrhoea sends thousands of children to the hospital and kills a large number too. New vaccines are available to protect against these pathogens and India is now gradually moving towards including these latest vaccines in the immunisation programme.

In fact, 2011-20 has been declared the ‘Decade of Vaccines’ by the global community. Awareness about the benefits of vaccines and advocacy for the introduction of new lifesaving vaccines must increase during this period. The health and well-being of millions of children will improve only when the importance of vaccines is acknowledged.

Vaccines provided under the Universal Immunisation Programme (UIP) in India offer children protection from just a handful of infections — tuberculosis, diphtheria, pertussis (whooping cough), tetanus, polio, measles and Hepatitis B across the country and Japanese encephalitis in some areas.

New vaccines against Hib and rotavirus have gained popularity in many countries. The benefits of these vaccines are yet to be maximised in India.

The three new vaccines that will benefit children the most in the country are the pentavalent vaccine that confers protection against Hib; the rotavirus vaccine and the pneumococcus conjugate vaccine.

Other countries have readily embraced these vaccines, and are deriving their benefits. Hib vaccine has been a part of routine immunisation programmes in several countries after WHO’s Strategic Advisory Group of Experts (SAGE), recommended in 2006 that this be included in national immunisation programmes. Of the 194 WHO Member States, 185 have adopted the pentavalent vaccine that protects against Hib.

And the benefits have been huge, since Hib diseases have almost disappeared in these parts of the world.

India too would derive massive benefits: 72,000 child deaths and nearly three million hospitalisations in India will be prevented each year once the Hib programme is established across the country.

In India, the pentavalent vaccine that contains Hib (and also protects against diphtheria, pertussis, tetanus, hepatitis B) has been popular for a decade in the private sector, and was included in the National Immunisation Programme more recently.

The vaccine was introduced in Tamil Nadu and Kerala in 2011 after endorsement by India’s National Technical Advisory Group on immunisation and a detailed review of vaccine safety coordinated by the Indian Council of Medical Research (ICMR).

Since then, the pentavalent vaccine has also been introduced in six additional states.

PENTAVALENT safety


The introduction of the pentavalent vaccine in some Asian countries has been associated with safety concerns.

This included reports of deaths shortly after vaccination in Sri Lanka, Bhutan, India, Pakistan, Nepal and Vietnam.

Because of these concerns, Sri Lanka, Bhutan and Vietnam temporarily suspended pentavalent vaccine use as a precautionary measure. In all countries, investigations by local governments, WHO and international experts have not demonstrated a causal link between vaccination and infant death.

As a result, Sri Lanka, Bhutan and Vietnam have resumed the use of pentavalent vaccine.

Faith in the safety of this vaccine was further reinforced after WHO’s Global Advisory Committee on Vaccine Safety reviewed the pentavalent vaccine safety data from four countries (Sri Lanka, Bhutan, India and Vietnam) and concluded that it was safe.

The Indian Academy of Paediatrics (IAP) has expressed concern about the misinformation being spread about the vaccine, and has denounced attempts to distort facts.

IAP maintains that pentavalent is safe and endorses the government’s decision to introduce the vaccine in six states.

While efforts should continue to ensure the safety of vaccines, the drive to introduce immunisation that reduces childhood illnesses and saves lives should not be compromised.

The WHO remains committed to working with the national government to enhance the benefits of safe and efficacious vaccines to India’s population.

(The author is WHO Representative to India)

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Re: Indian Health Care Sector

Postby Theo_Fidel » 14 Jan 2014 00:43

Well done India on Polio free status. Fantastic achievement against relentless odd!

Sobering observation from above. Guard needs to be kept up. So far herd immunity is protecting folks and herd immunity has to be maintained!

Yes, there is always the risk of reintroduction. Look at all the countries that have had outbreaks recently — Somalia, Tajikistan. They were polio-free countries. The disease is just a flight or a bus ride away. So we have to keep up the supplementary immunization rounds. Our routine immunizations have only reach 60, 61 percent nationally. And in some of the high-risk areas, it would be even lower. So we need to still press forward with them.

There are other questions that we have to address. Such as how long should we continue with the Oral Polio Vaccine? But we cannot shift to I.P.V. [inactive polio vaccine], the injectable, so easily. We would have to train people to give it to 174 million kids with syringes. That’s too difficult to execute.

The only solution is to rapidly get rid of the virus from the rest of the world so we don’t have to fear reintroduction. Bear in mind, that for every one polio case, there are 200 who are carriers of the virus but don’t manifest the disease. So it’s tricky.

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Re: Indian Health Care Sector

Postby arshyam » 02 Mar 2014 23:51

Cross-posting from the economy thread:

Suraj wrote:Here's something that will make vina do cartwheels:
Narendra Modi positions himself as 24-hour CEO-cum-COO

In Modi’s scheme of things, if you invest in cleanliness and preventive healthcare, the government’s health budget can actually be reduced. That’s a subtly radical idea no doubt – which any supply-side economist would approve of. Modi's belief in more governance, less government, clearly emerges in the details – if not the broad vision.


Reading this reminded me of an old article I read on Rediff. Admittedly, it is from 2009, but I don't remember reading much about policy changes at the central level beyond 'encouraging states', and our overall health indices aren't showing that much improvement. Good to see Modi talking about preventive healthcare, looks like Gujarat has seen some good benefits out of this change. I had no idea about a different health care stream till I read this article.

Healthcare is terrible in India, but Tamil Nadu shines - Shankar Acharya, Business Standard/Rediff

The most important thing for India is to resurrect public health services in the country, says Shankar Acharya.

The people of India suffer from terrible health. Nearly 40 per cent of all children under three years are stunted. Over half of all married women (age 15-49) are anaemic. The incidence of communicable diseases is rampant. Even the well-off often fall victim to outbreaks of diseases such as dengue, diarrhoea, malaria and hepatitis, not to mention swine flu.

The economic costs of ill-health are huge. For the poor, it is often catastrophic. Government spending on health amounts to hardly 1 per cent of GDP.

So, India needs a lot more government doctors and public hospitals and clinics to improve the situation, right? Well, may be. But perhaps even more important is the resurrection of public health services in the country.

Or so argue two new and provocative papers on this subject by Monica Das Gupta et al (henceforth 'authors'*).

They note that a country's health system consists of three components:

1) Population-wide preventive services to reduce exposure to disease through sanitary and health regulations and monitoring and averting health threats;

2) Clinical preventive services provided to individuals such as vaccination and screening; and

3) Medical services to care for and treat individuals with injuries and diseases.

The first two components constitute 'public health services' and the first alone is referred to as 'environmental health services'. The authors note that the great success of health advances in developed countries has come mainly from 'environmental services'. Yet, in most Indian states, this has become the most neglected Cinderella of the health system.

It was not always so. At Independence, the fledgling medical and public health were separate cadres, each with its separate career ladder.

Following the 1946 Bhore Committee report, the two services were unified in the central government and the states were instructed to follow suit. Over time, attention and resources gravitated towards medical services and led to the atrophying of the public health component.

Environmental health services suffered a second blow in the 1950s, when the shrinking resources for public health were increasingly channelled into single-focus programmes, such as smallpox and malaria eradication, to the detriment of broader environment health needs.

The process was aggravated in the 1970s by the separating out of public health engineering services from health departments. The final blow also came in the 1970s when all grassroots male health workers, including sanitary inspectors, were combined into a single cadre of 'multi-purpose workers'.

Soon, the environmental health work of sanitary inspectors was preempted by the focus on malaria and smallpox eradication. By 2002, the National Health Policy could recognise the crucial importance of environmental health factors in engendering good health outcomes and yet blithely state that such matters were outside the purview of the health ministry!

The marginalisation of environmental health services has been inadvertent but dreadfully costly for India's health and well-being.

One important state, which did not follow the herd and could light the way for the future, was Tamil Nadu. It offers a shining example of what can be achieved through effective and well-organised public health services.

Tamil Nadu has the best record in full child immunisation coverage and the percentage of women receiving antenatal and postnatal care. It has very good infant mortality trends over time, though this is obviously affected by other factors (beyond public health services) as well.

The state has never figured as the main locus of any major epidemic in recent decades (a key yardstick of successful public health is the absence of disease outbreaks). It deployed its unusual technical expertise to help control the 1994 plague outbreak in Gujarat.

The state demonstrated an excellent record in responding swiftly to the 2004 tsunami disaster in organising care for survivors and preventing epidemics.

And all this has been accomplished despite being India's third most urbanised state (after Goa and Mizoram), being one of the least endowed with fresh water sources, being one of the main poultry producers (but no bird flu epidemic), and with three international airports (but not an early hotspot for swine flu).

Moreover, all this has been achieved on a tight budget. Per capita public and private health expenditures in Tamil Nadu are below all-India averages.

So what, according to the authors, are the key ingredients of this remarkable success?

First, the Public Health Directorate has maintained its separate identity and mission since 1922 and has been staffed by a trained cadre of public health managers.

The Directorate has offered incentives and career paths in public health, thus minimising the national tendency for dominance of public health specialists by medical specialists.

Second, the Directorate has retained a separate budget, which has facilitated the planning, staffing and implementation of full-scope public health services. Thus, for example, Tamil Nadu has about 120 entomologists (contrasted with just a handful in most other states) who can contribute effectively to controlling vector-borne diseases.

Third, Tamil Nadu has a Public Health Act, which assigns responsibilities to different layers of government and agencies, sets standards of food hygiene, water quality et cetera and mandates regulation and inspection of agencies and establishments, including a broad authority to control any 'nuisance' that could threaten people's health. Fourth, there is a well-functioning professional public health cadre managing a team of non-medical specialists and lower-grade staff working solely on public health. This cadre has faster promotion avenues than medical cadre and enjoys considerable administrative responsibility and authority.

What about replicability? Can other states reorganise their health systems along the lines of Tamil Nadu and reap the major health benefits that seem to accrue? Yes, they can.

The administrative foundations are similar across the country. The key difference is that Tamil Nadu '(a) separates the medical officers into the public health and medical tracks, (b) requires those in the public health track to obtain a public health qualification in addition to their medical degree, and (c) orients their work towards managing population-wide health services and primary health care…".

The additional investment required to train a cadre of public health managers is modest: in Tamil Nadu, this cadre amounted to hardly 1 per cent of over 10,000 government doctors.

Of course, reverting to a separate Directorate of Public Health and having a good Public Health Act may also be necessary and quite feasible. And the data suggest that the costs are affordable. The central issue is not resources, but how they are organised, mandated and managed.

There are encouraging signs that necessary reforms may have begun. The National Health Bill 2009 seeks to encourage states to prepare Public Health Acts (Gujarat has already moved in this direction). The draft Public Health Emergency Bill is encouraging.

Much, much more needs to be done and there are very useful practical suggestions in these papers. For the sake of our health and our children's, we need to move fast.

And always remember: "Focusing on clinical services while neglecting services that reduce exposure to disease is like mopping up the floor continuously while leaving the tap running!"

The author is Honorary Professor at ICRIER and former Chief Economic Adviser to the Government of India. Views expressed are personal.

* "How might India's public health systems be strengthened?" by Monica Das Gupta, Rajendra Shukla, T V Somanathan and KK Datta, World Bank Policy Research Working Paper 5140, November 2009; and "How to improve public health systems: the lessons from Tamil Nadu", by Monica Das Gupta, BR Desikachari, TV Somanathan and P Padmanaban, World Bank Policy Research Working Paper 5073, October 2009.


Shankar Acharya

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Re: Indian Health Care Sector

Postby arshyam » 02 Mar 2014 23:55

Theo_Fidel wrote:Sobering observation from above. Guard needs to be kept up. So far herd immunity is protecting folks and herd immunity has to be maintained!


True, that. Apparently, there has been some new outbreak in California, need to watch out. I am happy to see folks in India keeping an eye on such things.

Doctors told to be alert as US witnesses child paralysis cases - Shastry V. Mallady, The Hindu

In the wake of paralysis cases being reported among children in California in the US, the Indian Public Health Association (IPHA) has cautioned paediatricians to be more alert as India has only now managed to eradicate polio after a long battle.

The association has issued an alert to public health officials in Tamil Nadu to sensitise paediatricians and district-level health officers to the “polio-like” illness that the children are afflicted with in California, and the follow-up being done by doctors and researchers in that country.

S. Elango, State president, IPHA, told The Hindu on Wednesday that even though there was nothing to panic as such in India, it would be prudent to be “doubly cautious” at this stage since there was every possibility that paralysis syndrome could occur in India.

“Polio was eradicated decades ago in the US. When a polio-like disease was reported in that country, it is a caution to the entire world not to be complacent – especially to India which was certified polio-free only this year. Good flight connectivity between the two countries creates a good chance for the import of that disease,” he said.

He said the role of paediatricians became vital against this backdrop. “This is an emerging infection which could spread fear in the coming days. The research work of the Centre for Disease Control in Atlanta in the US is important for public health administration everywhere,” he added.

Appealing to the Tamil Nadu Health Department to sustain its focus on preventing polio, Dr.Elango, who is a former Director of Public Health, said the IPHA would soon write to the Union Health Ministry and the State governments to undertake more epidemiological studies of paralysis.

“There will be claims and counterclaims on what has happened in California. But, let us admit the fact that a new virus is emerging to cripple children. That calls for intensive surveillance and active participation of paediatricians,” he noted.

He suggested that the Director of Public Health, Tamil Nadu, discuss the issue in the next review meeting with district health officials.

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Re: Indian Health Care Sector

Postby Varoon Shekhar » 13 Mar 2014 16:12

Another Indian pharma co under the scanner. But why only in the US, why not in Japan, Australia, Europe, Russia etc?

http://www.thehindubusinessline.com/com ... epage=true

Mumbai, Mar 13:

Drug-maker Sun Pharmaceutical said on Thursday that its cephalosporin facility located at Karkhadi, Gujarat, received an import alert from the United States Food and Drug Administration.

The alert was issued by the US FDA as a follow up to the last inspection of the facility, during which some non-compliance of current Good Manufacturing Practice (GMP) regulations were identified, the company said.

The company’s stock price dipped about 4 per cent to Rs 580, on the BSE, in afternoon trade.

Sun’s import alert comes even as India-based companies like

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Re: Indian Health Care Sector

Postby panduranghari » 13 Mar 2014 18:41

Austin wrote:What Govts Spend On Health Care

At 60%, India has one of the highest out-of-pocket health care expenditures. Besides, the country has only 6.49 doctors per 10,000 people, lower than even Pakistan, which spends just 2.5% of its GDP on health care.




Image

That does not take into account the modalities of treatment considered non mainstream. Also the west is heavily dependant on imported labour for healthcare too. I seriously doubt if they can maintain that much spending without spending more in the foreseeable future. If money dries out, why should a doctor carry on working in the west?

At some stage, the non mainstream modalities have to brought into mainstream for the ability of healthcare professionals to serve more people. With the current system, providing non mainstream treatment is considered backward, professionally scorned and may even invite censure from the regulatory authorities.

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Re: Indian Health Care Sector

Postby SSridhar » 27 Mar 2014 19:06

WHO certifies India Polio-free
Eleven countries, including India, was certified polio-free on Thursday by an independent commission of the World Health Organisation (WHO) with no case of the disease being reported in the country for three years.

The WHO’s South-East Asia Region comprises Bangladesh, Bhutan, Democratic People’s Republic of Korea, India, Indonesia, Maldives, Myanmar, Nepal, Sri Lanka, Thailand and Timor-Leste. All 11 countries were declared polio-free.

A panel of 11 experts in public health, epidemiology, virology, clinical medicine and related specialities met for two days at the WHO’s regional headquarters in New Delhi to review evidence before reaching the decision.

The South-East Asia region, home to a quarter of the world’s population, is the fourth of six WHO regions to be declared polio-free.

“This is a momentous victory... It is a sign of what we can bequeath our children when we work together,” said Poonam Khetrapal Singh, regional director for the WHO South-East Asia Region.

In 2009, India’s 741 polio infections accounted for nearly half the world’s total. But a public immunization campaign made 2010 a turning point with only 42 cases.

Over the past decade, India’s polio eradication programme involved 2.3 million health workers and volunteers. More than 170 million children under the age of 5 have been vaccinated annually. {Massive effort. Congratulations}

The last polio case was recorded on January 13, 2011 in West Bengal state. In 2012, the WHO removed India from the list of polio-endemic countries.

Dr. Khetrapal also sounded a word of caution, saying: “Until polio is globally eradicated, all countries are at risk and the region’s polio-free status remains fragile.” The disease remains officially endemic in Pakistan, Afghanistan and Nigeria.

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Re: Indian Health Care Sector

Postby SSridhar » 31 Mar 2014 10:52

For India, the challenge is to remain polio-free - Business Line
On the day India was feted by the World Health Organisation (WHO) for clocking three polio-free years, reports coming out of Iraq spoke of a suspected case of polio re-infection — its first in 14 years.

A grim reminder that being polio-free was just part of the battle — the challenge was in staying that way, especially since neighbouring Pakistan, besides Nigeria and Afghanistan are still reporting cases of polio.

Countries are vulnerable until polio is eradicated everywhere, says WHO’s Poonam Khetrapal Singh, adding that India will have to continue its routine immunisation programme, with surveillance and emergency response playing a significant part in picking up and tackling possible incidents of re-infection.

Being polio-free is a huge milestone, but it is not the end of the story, says Singh, who heads the 11-country South East Asian region that has also become polio-free, following India’s achievement.

Instability, re-infection

The re-infection reported in Iraq seems to be similar to that in Syria seen months ago, and possibly of Pakistani-origin, says Sona Bari, WHO spokesperson on global polio eradication. Besides, Iraq and Syria, Jordan is of great concern, she says, adding that conflict and instability prevents children from being immunised, leading to “heart-breaking” incidents of infection.

“The virus is very good at finding children and our task is to find these children and get them vaccinated,” she says, adding that the WHO was involved in a vaccination campaign covering 22 million children in regions including Iraq, Jordan, Syria, Egypt and Gaza.

The WHO polio endgame plan expects to eradicate polio from the world by 2018.

It has now come down to eradicating cases in Pakistan and Nigeria, as Afghanistan’s cases are a fall-out of proximity to Pakistan, says Bari.

Besides, conflict-hit regions and the resulting displacement of people make it hard to run immunisation programmes.

Polio vaccination drives are sometimes also viewed with suspicion with fears that it is a tool to sterilise people .

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Re: Indian Health Care Sector

Postby krishnan » 31 Mar 2014 11:02

how many paki so called docs are really certified ???

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Re: Indian Health Care Sector

Postby SSridhar » 07 Apr 2014 09:00

Neutralizing a mass killer - Edit in The Hindu
The curiosity and keen observation shown by a single doctor at the All-India Institute of Medical Sciences in New Delhi in 1985, combined with unprecedented team work by people from 13 institutions, both in India and abroad, would soon start annually saving the lives of thousands of children aged less than five years from a mass killer — rotavirus diarrhoea. In India, the disease annually kills over 100,000 children below the age of one, making the country account for a quarter of all global deaths caused by rotavirus diarrhoea. The majority of instances of the disease caused by the virus occurs during the first two years of age. According to results published recently in The Lancet, a Phase III trial of an indigenously developed rotavirus vaccine 116E carried out in three centres was found to be safe; it had 56.4 per cent efficacy in preventing severe rotavirus gastroenteritis in infants during their first year of life. Though the efficacy of the vaccine is only modest, it is superior to currently available ones. In the case of high-burden countries like India, even the modest efficacy of the vaccine would go a long way in reducing the number of deaths. The efficacy would further shoot up when widespread immunity is achieved through sustained vaccination of a majority of infants. Hence, there is a real possibility of the number of deaths dropping sharply in a few years after the introduction of the vaccine. It can also bring about a major reduction in the number of instances of hospitalisation in those aged below five, within two years of its introduction.

The vaccine, which would be made available to the government at not more than $1 a dose, is expected to be licensed shortly. It is imperative that the government quickly includes it in the national immunisation programme. The fact that three doses can be co-administered with other vaccines during the routine immunisation schedule makes it all the more attractive. While it is true that improving sanitation and hygiene levels is insufficient to rein in rotavirus diarrhoea, there is a compelling need to improve social infrastructure in order to control other pathogen-caused diseases like cholera. Besides the direct benefits from the vaccine, the isolation of the human neo-natal rotavirus strain and the conduct of clinical trials in India have given the science of vaccine development a much-needed boost. Though it has taken nearly 30 years to reach this stage, the development of this vaccine proves that Indian companies can take to completion clinical trials of novel drug candidates. In fact, the government should adopt the same model to develop drugs for other neglected tropical diseases that primarily affect people living in poverty in the developing countries.

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Re: Indian Health Care Sector

Postby chandrasekhar.m » 07 Apr 2014 11:09

In fact, the government should adopt the same model to develop drugs for other neglected tropical diseases that primarily affect people living in poverty in the developing countries.

Thanks for posting this, saar. Too bad they didn't give any more information about that observant doctor or a more detailed story.
Are there other success stories where government or private Indian doctors/organisations have found out causes or taken a vaccine/drug for such tropical diseases from conception to completion and wide availability? I will also do some searching in the mean time.
The one I remember cannot really be termed Indian - that of malaria and Ronald Ross.

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Re: Indian Health Care Sector

Postby SSridhar » 08 Apr 2014 17:28

chandrasekhar.m wrote:Too bad they didn't give any more information about that observant doctor or a more detailed story.

True, I was also disappointed.

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Re: Indian Health Care Sector

Postby Yugandhar » 08 Apr 2014 18:37

chandrasekhar.m wrote:
Too bad they didn't give any more information about that observant doctor or a more detailed story.

True, I was also disappointed.


That single doctor is "Dr. MK Bhan", who was also DBT secretary till Vijayaraghavan took over. Such an observation was also made at IISc and a similar asymptomatic strain was isolated, called I321. Both 116E from AIIMS and I321 from IISc were taken forward as potential vaccine candidates and during trials 116E was chosen to be taken for further development.

You can read the following paper if interested.
http://jid.oxfordjournals.org/content/1 ... 1/S30.long

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Re: Indian Health Care Sector

Postby Supratik » 08 Apr 2014 21:06

Yes, it is Dr. M.K. Bhan. Meanwhile, Sun Pharma buys the troubled Ranbaxy from the Japanese for $4 billion.

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Re: Indian Health Care Sector

Postby SSridhar » 09 Apr 2014 10:28

Yugandhar & Supratik, thanks for the inffo.

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Re: Indian Health Care Sector

Postby chandrasekhar.m » 14 Apr 2014 06:23

Yugandhar wrote:
chandrasekhar.m wrote:
Too bad they didn't give any more information about that observant doctor or a more detailed story.

True, I was also disappointed.


That single doctor is "Dr. MK Bhan", who was also DBT secretary till Vijayaraghavan took over. Such an observation was also made at IISc and a similar asymptomatic strain was isolated, called I321. Both 116E from AIIMS and I321 from IISc were taken forward as potential vaccine candidates and during trials 116E was chosen to be taken for further development.

You can read the following paper if interested.
http://jid.oxfordjournals.org/content/1 ... 1/S30.long

Thank you both, Yugandhar and Supratik.
Sorry for the late response, I wanted to reply after reading the paper. I am glad I read it.
Even I who know only high school biology could finish reading it, though there were some parts that were highly technical.

Some questions:
- The first pilot vaccine was made in 1996 and a clinical trial was conducted in USA. I am assuming that must have been done in 1996/1997 or atleast before 2000. Was that clinical studies program stopped and hence it was re-started again in India? I am trying to understand the motivation behind making it a wholly indigenous affair.
- What happened to this initiative between 1996 and 2005 as this paper was published in 2005. Moreover, I am guessing the trials in India took about 5-8 years as that news article was published this year. Is that the normal time taken or did they do it quicker than average?
- How did they identify the "outbreak" when the virus caused no disease symptoms?

I am glad that I know atleast now that we have the institutions and processes to do such R&D in India.

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Re: Indian Health Care Sector

Postby Supratik » 14 Apr 2014 16:12

I am not aware of the exact sequence of events as to why it took so long but normally it takes about 10 yrs from discovery to market. Rotavirus vaccines are available from MNCs but their efficacy on the Indian population is low. This one is an improvement but is still only ~55% efficacy. So more needs to be done.

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Re: Indian Health Care Sector

Postby Yugandhar » 14 Apr 2014 19:44

The first pilot vaccine was made in 1996 and a clinical trial was conducted in USA. I am assuming that must have been done in 1996/1997 or atleast before 2000. Was that clinical studies program stopped and hence it was re-started again in India? I am trying to understand the motivation behind making it a wholly indigenous affair.
- What happened to this initiative between 1996 and 2005 as this paper was published in 2005. Moreover, I am guessing the trials in India took about 5-8 years as that news article was published this year. Is that the normal time taken or did they do it quicker than average?
- How did they identify the "outbreak" when the virus caused no disease symptoms?


Well, I can`t answer all your questions as I am not aware very intimately about the approaches 116E went through. These strains were isolated during routine monitoring of rotaviral diarrhea in the population. Young children are screened regularly for two or more years and stools samples are screened for the virus. if you find the virus in normal stool samples it is an asymptomatic strain, and you suddenly see a lot of children having this virus in their system and no diarrhea and also they fail to develop disease in the period of follow up. So that's how you get the 116E and I321.

These asymptomats in India arose due to natural hybrid/reassortment of animal origin and human viruses and have lost their virulence. So good natural candidates for vaccine as they can replicate in the host and trigger immune response and not cause disease. This is like the polio vaccine (Sabin) that has been used in India (live attenuated).

By the time we developed these vaccines MNC pharma`s (Merck, GSK) came up up with their vaccines. These were developed in the west and relevant for the prevalent strains in the west. But the strains in India are different and varied.

A lot work would have been done between 96 and 2005 as the virus needs to be grown in large amounts and ensuring that it does not undergo any mutations which would change its nature and most importantly finding Indian pharma partners tot ake up thsi technology. a lot of firsts in this case and there fore a slow process. IMO after Shanta Biotech our industry developed greater confidence in itself in developing indigenous vaccines.

We may never get a 100% effective vaccine due to the diversity of the virus in nature and 55% is still good enough to reduce disease burden significantly.


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