Public Health

A new approach to Public Health: Transforming Maternal and Newborn Care in Telangana

More than 659,000 newborn babies die every year in India. It is the highest number of newborn deaths in the world. The country also accounts for twenty percent of all maternal deaths worldwide, with more than 150 women dying in India each day due to preventable causes related to pregnancy and childbirth. Concerns about maternal mortality ratio and infant mortality rate keep surfacing. Both remain unacceptably high and too much focus is put on childbirth itself and not the periods before or after. India is committed to reaching the Global Sustainable Development Goals and achieving its own national development goals. To improve the quality of care during the intrapartum and postpartum periods, in 2016 the Indian Ministry of Health and Family Welfare released guidelines for the standardization of all labor rooms. This was primarily to reach development targets on maternal and newborn mortality. The guidelines help states reorganize their labor rooms for maximum efficiency and quality service delivery.

Public Health

Is having insurance (private and public) really the answer to India’s healthcare issues?

Reading Dr Vikram’s post on “is-health-insurance-the-answer-to-indias-healthcare-woes?” made me think. Well, in the United States, despite healthcare being the highest capita spend of the GDP as per Organization for economic Co-operation and development (OECD) survey. But yet still we are unable to meet the healthcare needs of the population. That made me think – Is having insurance (private and public) the answer to India’s healthcare issues?

I would like to give my perspective whether we should invest heavily in insurance and the role of the government, based on my knowledge of Unites States healthcare systems.

Public Health

How alcoholism is creating a socio-economic problem in India?


Alcoholism has many negative connotations in India. Not only is it considered an unfavorable practice but also one which is banned on religious days. But the above graph shows a very different story with Alcohol indeed being consumed by 25-50 % of men in most regions of the country.

Though most of the recent references to alcohol are in the urban areas, where growing western lifestyle is seeing young men and women consuming beverages laden with alcohol, the severe socio-economic implications of this practice are in the rural hinterlands.

My interest in the subject started one day during the visit to Kerala. I was there to attend a Toastmasters conference and to my amazement I found out that all wine shops were closed in Kerala on the first of a month. This was because all salaries were given on the first and most men would take that money directly to the booze shop rather than the bank or the house.

In fact an average male in Kerala consumes 8 litres per capita that is double the country average for India. Some states in the country like Mizoram, Manipur and Gujrat have banned the consumption of alcohol. But still many other states have no such rules except the age limits.

Alcohol leads to some health implications, which in turn lead to economic implications for the affected families.

The most common condition associated with alcohol is cirrhosis of the liver. Other complications include- Diabetes Mellitus, Cancer, Coronary heart Disease, poisoning and epilepsy.

But the most important complication resulting from this is the addictive nature of alcohol consumption which often leads to repeat purchase and is currently driving the growth of the Industry. In rural India the use of alcohol leads to loss of pay. Most workers in these areas are working on daily wages and inability to work due to intoxicated state leads to this issue.

To add to this is the complex problem of not having Government health cover leads to these workers and their families taking loans from money lenders which finally leads to their perdition.

So alcohol in India has very difficult socio-economic questions. This can be sometimes the hidden cause for rural indebtedness and loss of pay.

Though some states have banned the consumption of alcohol, I think education is the best way to deal with the issue. Already some Government channels like All India Radio run programs in various languages focusing on the challenges with Alcohol and its implications. Also many NGOs have started working with women and educating them on the ills of alcoholic husbands on the family. Interestingly many estate owners in Coorg and Munnar now hand over the monthly salaries of the workers to the wife’s, so stop these men from wasting money on Alcohol.

As India chugs into a world of development, it is habits like these that keep the rural folks still in the dark ages and it is upto to society to take its destiny in its own hands by saying no to Alcohol.

As usual I would love to hear your views. How can we help people in the hinterlands overcome this addiction which destroys entire societies? Suggestions and thoughts welcome.



Healthcare Start ups Healthcare Technology Public Health

How Tele-medicine is changing Healthcare delivery in India

when we talk of tele-medicine the first thing that comes to our mind is helplines. Like the 104 helpline that has been running in Assam and Andhra Pradesh.  The success of the 104 helpline has led to it being set up in Karnataka as well.

But Tele-Medicine is more than just helplines. It is the delivery of healthcare consultancy, advice and treatment guidelines over technology negating the need for the patient and doctor to be co-located. It is nothing but the extension of how we work in virtual teams, connected by internet and telephony.

What makes Tele-Medicine a necessity in India is the distribution of the Indian population, 70 % of which is spread over 700,000 villages in India, most with population less than 1000 people. The second factor necessitating the need for Tele-Medicine in India is the lack of doctors and trained nurses. If current estimates are to believed there is a short fall of 600,ooo doctors in India. To add to it now we have low cost portable monitoring device like the $ 100 Ultra Sound developed by GE. and Finally we have the wide spread reach of mobile communication, where India has more mobile phones than toilets.

According to a report by Infinity research the global tele-medicine market is around $ 9 billion with a CAGR of around 20 %. But the Indian market is relatively very small at about $ 7.5 Million according to a quote from KSA Technopak in a Wharton interview.

When I was a practicing dentist, I would often receive telephone calls from my friends and relatives for advice on their dental problems. I have also analysed and studies X rays sent over MMS and SMS and given by diagnosis. So I was way into Tele-medicine space before it was established as a practice. Even today my colleagues  give advice and prescriptions to their patients over phone for non critical symptoms.

But the challenge remains can doctors make money by consulting over phone? Because the basis of capitalism is gtting compensated for effort otherwise the idea does not take off.

hellomy_logoIn my search for the answer, I came across the Hyderabad based start up “Hello my Doctor”. Founded by Raj SN, the venture is looking at ways to monetize phone consultations for doctors. ” Most Doctors are already consulting patients over phone” Says Raj, “Our vision was to create a platform by whoch doctors could provide consultation for their existing patients”.

The system is based on the simple fact that doctors should be able to provide preliminary care over phone and cal only those patients that require intervention to the clinics. That was both the doctor and the patientcan optimize their time.  Currently Hello my doctor has around 150 doctors already registered, and Raj and his team are embarking on the next step and that is to educate the patients on the advantages of Tele-medicine consulting.

The process is simple, the patients receive a toll  number and an extension number of the doctor they want to reach. The doctor chooses how much he wants to charge for the consultation. ” We usually advice the doctors to set limits per minute as it goes along with the call metering methodology followed by most telecom providers”

The patient has to buy coupons for various denominations from the site and then he can call his doctor. The doctor also sets the best times that he is available for the consultation. So this is a win win situation as the doctor saves time and gets paid for consulting over phone and the patient is able to talk to the doctor and probably avoid a visit to the clinic.

But doctors want more than just tele-consulting their existing patients, they would ideally want to take on more patients through this medium. and this is where patient education becomes important and a necessary step for the idea to succeed.

This model is  unique and has been successfully been implemented in UP by US based World Health Partners. They have set up an extensive Tele-Medicine network in UP, which has received almost 35,000 calls till date since 2008. All patients requiring intervention are then directed to WHP’s franchisee clinics in the area. The model covers Meerut, Bijnor and Muzzafarnagar. The solution is branded under the name of Sky Care Providers and Sky Health Centers. All of them are provided basic training and given infrastructure to enable them to run the Tele-Medicine centers.

Similar system is being run by Apollo group, Narayana Hruduyalaya, Aravind Eye Hospital and Asia Heart Foundation. But none of them have the scale currently to cover the entire nation.

In such a situation the state supported 104 numbers seem to be the best bets.  also in my opinion there is a need to develop these facilities with a focus on providing primary care and basic consultation which can cover the bulk of the Indian population.

But a public helpline number funded by Pharmaceutical and Medical Device firms seems to be another option that is opening up. Raj SN of Hello my Doctor is working on one such model.

Some very successful initiatives like the AIDs helpline in Hyderabad are a testament to the fact that Tele-medicine has a future in the country.”The AIDs helpline receives more than 700 calls a day” Says Raj “And that shows that there is a need”

In conclusion, Telemedicine is all set to erupt in the Indian Healthcare Space. What it needs is a push and hopefully efforts like the 104 numbers and ‘Hello my Doctor” would just give the right fillip to lead India to healthier times.



Public Health

Karnataka to launch Healthcare Information Helpline through 104 number

India may have many challenges on the Healthcare front but one cannot deny the new initiatives being taken by state governments to improve the standards. Earlier this year I wrote about E Mamta the initiative from the government of Gujrat to reduce mortality rates among mothers and infants. This week the government of Karnataka is launching the Healthcare Information Helpline.

The Helpline is going to be available by dialing 104 on your land lines  The network infrastructure is being provided by BSNL. The system would have the capability to support 100 simultaneous calls with the capacity to expand to 300 calls if required. Currently the government has sanctioned around 7 crores to buy the hardware and software infrastructure to handle this center.

Though the location is not known as yet, the plans are to acquire 1500 Sq feet location in Hubli to build the call center. The center would be manned by doctors who would provide consultation for minor ailments and follow it up with a sms prescription for the callers. For serious ailments the center would fix up appointments with specialists. The helpline would also cater to patients suffering from mental ailments, with doctors providing counselling services. Initially the center would have the capability to handle 100 calls simultaneously .

Also the government estimates that it will take around 70 lakhs a month to run the center and has allocated 9 crores for operational use. The helpline has been successfully implemented in states like Andhra Pradesh and Assam.

In my opinion this is a great idea.

One the helpline would definitely reduce the need for patients with minor ailments to visit hospitals. This not only saves the time of the patients but also reduces the stress on the exiting healthcare infrastructure. As the patient could reach the helpline immediately, it would be easier to detect and treat conditions that have the potential to become major conditions.

Secondly as the center would be set up in a smaller city, it will create new avenues for employment in the area.

Thirdly many times patients with mental illnesses do not get the care that they deserve. It could be a combination of social stigma and a lack of trained professionals to handle such cases. The helpline would reduce the gap and help from that respect.

Overall I think this is a great initiative but again like all government initiatives would need excellence in execution to achieve its goal.