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Public Health Uncategorized

National Health Blue Print 2019

Niti Aayog in July 2019 has finally released the digital health blueprint policy for India. The focus of the digital health blueprint is in line 2017 National health policy which focuses on long with a strong emphasis on the care continuum. National health policy also plays a lot of emphasis on the Triple Aims that include

1)Accessibility

2) Affordability

3) Quality of care

National Digital Health blueprint truly recognises that there is no one entity or organisation that can solve the Healthcare problems of India it calls the blueprint for the entire Healthcare system this is a strong departure from the traditional ideology that the government is the sole provider of healthcare for all citizens.

National health blueprint focuses on three major components

  1. Digital health infrastructure number
  2. Digital data
  3. Standards and regulations

Meeting key healthcare objectives

The key objectives of the national digital health blueprint include establishing the core data model for storing and using healthcare data that would be generated from this ecosystem. Standards for the infrastructure required for its seamless integration using standards for all the components of the ecosystem.

The other interesting aspect is creating a system of Personal Health Records, based on international standards, and easily accessible to the citizens and to the service providers, based on citizen-consent.

There is also a provision for declassifying data for usage for analytics and doing population health management. In addition to these, there is guidance on governance, leveraging information systems already in place.

Finally, the 4 building blocks of the policy are

  1. Identification- Identifying the citizen and ensuring that his corresponding health data is mapped to his id. This is possible through Personal health identifier and through the health registries
  2. Citizen in the center- All access and control of the data lie with the citizen. This is enforced through consent manager, Anonymizer and Privacy Operations Center.
  3. Interoperability- Data should be available through health information exchange and National Health Informatics Standards.
  4. Access – Governed by Mobile First and a Digital Web portal strategy

I would encourage you to download the blue print report and study the implications of the report for your self. Looking forward to your comments.

Categories
Public Health

Healthcare in union budget 2019

I was shocked to see only a passing mention of the healthcare sector in the healthcare budget 2019. For years healthcare as a sector has been neglected and though there are efforts by the government, it is clearly not enough to revive the stagnating rural health system in India.

The finance minister made a passing reference to the sector, stating that according to the vision presented in the interim budget, “a healthy society would remain an area of attention for the government, which she attributed to factors like Ayushman Bharat and well-nourished children and women.” This was during her Union Budget 2019 presentation yesterday in the Parliament while addressing the healthcare budget 2019.

The healthcare budget 2019 spend sees a 15% rise in terms of allocation to the finances to the ministry of health and family welfare. In 2019-2020 the ministry would have access to INR 62659 crores to spend on the health and welfare of the nation.

Also, the budget to the National Rural Health Mission has increased by 7 % to INR 27,039 Crores in the healthcare budget 2019. Also, there has been a marginal increase to the National Urban Health Mission to INR 950 Crores.

Where does all this leave us? Well not very well I am afraid.

The Primary Health Care (PHC) system is crying out for reform with only 20% fulfilling the minimum criteria for Indian Public Health Standards. Almost 5 % of the PHCs are without doctors and almost 60% have only 1 doctor servicing the population. We had discussed the importance of rural health in the overall healthcare reforms in India in an article in 2017.

In analyzing the election manifestos of political parties, from 2014 elections, we realised that healthcare is not an election issue. The report would be available in a months time, but on initial analysis, health occupies about 2-6 % of the manifesto.

Keep tuned to read more on this in our follow up stories.

But today the question to you is, what would an ideal healthcare budget look like if we had to provide access to quality healthcare to a billion plus people? We would like to hear your thoughts on the same.

References

https://www.downtoearth.org.in/news/health/union-budget-2019-20-hardly-any-mention-of-health-sector-in-budget-speech-65467
Categories
Healthcare Delivery

How Vitamin D Deficiency could be silently killing you

In 2014 my wife decided to hire a trainer to help her with her fitness. I was curious how this would work and hence I also decided to go with the same trainer. I spoke to the trainer from the Chennai airport where I was on that day on a business trip and then processed to hire her.

I am no stranger to workouts and I had been leveraging trainers before in the various gyms that I had visited. But this was different. As my training started the first thing I remember was that there was intense pain in my muscles and joints. Despite pain killers, the pain would not go away. The trainer kept telling me that it was a matter of time and things would improve. She even brought in another trainer, who helped me with some stretching exercises and twisting. But when things got worse I had to consult my family physician. One look at me, he said, well my friend when was the last time you checked your Vitamin D levels? That started a quest for settling my Vitamin D levels which continues till this day.

Vitamin D Deficiency Symptoms
D vitamin is known since it is produced by the exposure to sunlight light. It is an important element that a human body requires. Deficiency is a critical problem. The below mentioned are a number of the common signs of lack of D vitamin. Vitamin and mineral basic’s consumption is critical for a human body to work. There is a lot of information what’re the sources of these nutrients and concerning the significance of the nutrients.  

In 2010, the venerable Institute of Medicine (IOM) issued a report based on a lengthy examination of data by a group of experts. To sum up, they estimated that a vitamin D level of 20 ng/mL or higher was adequate for good bone health, and subsequently, a level below 20 was considered a vitamin D deficiency. (Source:
https://www.health.harvard.edu/blog/vitamin-d-whats-right-level-2016121910893 )

Below are the charts I have kept for my Vitamin D Levels. As you can see I started with a deficiency around 11 and now have managed to keep myself above the 20 mark for the last 5 years.

Key Symptoms

Weakness and Pain: The weakness of bones and muscles is the first sign that there might be a problem. Rickets in children and Osteomyelitis in adults are among the largest of deficiency of D vitamin deficiency symptoms. Weak bones are vitamin d.’s feature However they generally occur at an early age or older age.

Obesity: individuals who’re obese are more common in showing that the signs of lack of D vitamin. Now, this could be one of the reasons for the obesity epidemic in India.

Feeling Low: Difficult to explain but lack of sunlight is known to cause subclinical depression. This often leads to mood swings, lethargy among others

Other Symptoms: Some other signs are knock-kneed appearance, low blood calcium level, high blood pressure level, reasons why that the vitamin d deficiency occurs are given below.

Reasons for Deficiency

The numerous reasons why that the vitamin d deficiency occurs are given below.

  1. Less exposure to direct sunlight
  2. Extensive use of sunblocks and sunscreen
  3. Lack of absorbing of D vitamin.
  4. Hereditary factors

The given are a number of the readily recognize able signs of vitamin D deficiency symptoms. So what do you do?? In my opinion these should be your next steps.

  1. Visit a doctor- Please do not self medicate, please do visit a doctor
  2. Check your Vitamin D Levels regularly from a NABL certified Lab
  3. Plan for at least 30 minutes of outdoor activity daily specially in the morning- Walks, Jogs or just stretching in the park is a good idea.
  4. Keep a record of your levels

I trust this article is helpful in understanding your symptoms and seeking the right help. As always we are open to your questions and we will do our best to answer them.

Categories
Wellness

The curious rise of mental illness in India

Rahul (name changed) was having a tough time at office. He had worked his way to the top of the finance industry in Mumbai India. He was now a Sr VP at a financial institution and looking forward to a great time steering the entry of a new financial institution in India. But somehow his work load was increasing. What started as a stretch project spanning a few weekends, had consumed him for months. Soon he started dreading the thought of going to office. Even at work his ability to cope with work was reducing, affecting his effectiveness. Soon he was in a cycle, where stress was eating away at his ability to get things done, which contributes to further delays and more stress. Soon panic attacks started hitting him in the office. He would sweat profusely and remain tense throughout the day.

Rahul was lucky that he recognised some of the symptoms and sought medical help. He reached out to a counsellor and started treatment immedicably. He also took a break from work and focused entirely on his wellbeing. Slowly over a period with counselling and medication, Rahul felt better as the incidents of panic attack and their severity started reducing. Before long he was back at a new job, this time with the knowledge that he would have to handle his work better and avoid triggers that might set off the attacks again.

Rahul’s case is not an isolated case. I remember when I joined the technology world, my first job was with this healthcare network. A middle level manager who was my mentor at that time used to warn me about not taking projects with pressure. He said it was just not worth it. Coming from the medical world, we know all about pressure and its physiology that helps us a humans trigger the flight or fight reflex.

According to a report published by the World Economic Forum in 2014 on the impact of non-communicable diseases on Indian economy it is projected that the loss due to lack of mental health would run into trillions.

“The evidence is compelling. India stands to lose $4.58 trillion before 2030 due to NCDs and mental health conditions. Cardiovascular diseases, accounting for $2.17 trillion, and mental health conditions ($1.03 trillion), will lead the way in economic loss.”

So today we stand at the crossroads of healthcare highway, where mental well being is going to cost us more than Diabetes and Cancer put together by 2030. India it seems is one of the most depressed country in the world. We have close to 6.7 % of the population that is suffering from some mental illness. And just like Diabetes there is no specific urban/rural divide on this. So, the common feeling that people in the villages are not affecting by depression is not true. On the other hand, I feel they are worse off as there is limited awareness and facilities available in the rural areas. According to a WHO report done by National Care of Mental Health, suicide rates in India are around 10.7 per lakh of population and they are mostly below 44 years.

What should one do if you felt tings were not ok mentally?

Well for starters contact your physician immediately. Best not to self diagnose. I myself had consulted my physician after the death of my mother and visited a counsellor.

The secondly seek support from family and friends. I had taken my wife into confidence during that time. She had accompanied me to the session.

Finally, no matter how bad it may seem there is no justification for self-harm. If such thoughts to occur, best to take help from one of the many depression helplines. I have a list that I found at a website, not sure if this is current but still a good list to use.

In conclusion, mental health is a clear and present danger for us in India. Rising expectations and the collapse of work life balance has brought us to this situation. I still feel digital can help in specially providing immediate, anonymous counselling. Work is important but not at the cost of life. Do take care and keep smiling.

Categories
Healthcare Delivery

Why hbA1c levels are the key to your diabetes management?

The average life of the Red Bood Cell (RBC), is around 120 days. With an estimated half-life of 2-3 months, it is a good indication of the overall health of the individual. Glucose molecules in the blood combined with hemoglobin, and through this glycation form a ketoamine that is stable and can be used as a measure of the glucose in the blood. Since 1970’s hbA1c measures have been recommended as a standard of care for diabetes management.

Why is this a better measure than the traditional fasting and Post-Prandial measures(PP)?

  1. Firstly measuring hbA1c gives us the story for 90 days. So it not a point in time investigation rather its a holistic view of the system.
  2. It is human tendency to cheat if we know that a blood sugar test is looming. I have seen my mother do that many times and there are dietary adjustments made just before the test that can give us a false negative.
  3. Thirdly the test does not require any fasting or dietary restrictions, hence the compliance is better.

For more scientific details on this method, please do read this article on the research already conducted.

While these are great reasons to conduct the test, the key to the test is to go to an accredited lab. Always insist on choosing a NABL (National Accreditation Board for Testing and Calibration Laboratories) accredited lab. I have often heard of samples getting mixed up between patients. This is mostly true of the many labs providing online services or online firms serving as aggregators.

Finally, talk to your doctor on why you should consider mapping this level. I have been doing my tests over a period of time and last few months results are below. These tests have given my physician a good indication as to why we need more aggressive intervention in my case.

Anyways do let me know if you have any questions on diabetes management and I would be happy to answer them for you.