Healthcare Delivery Public Health

Why breast cancer could be a big looming challenge for India ?


The very word strikes terror in the hearts of patients and physicians alike.

But often we consider cancer as a problem of the west and one that does not really affect India. Except for tobacco related cancer, there is hardly any public outreach program either from the Government or the private health sector.

India has almost 3-4 million cancer patients. The number could be much higher as the detection mechanisms in India are almost not present. 70% of these cancer patients come in at stage 3 or 4 where the prognosis is very bad.  Almost a million cancer are detected annually and the number of cancer patients in India could be around 7 million in the next couple of years.

Women though less prone to tobacco related cancer are more prone to Cervical and breast cancer. These two types account for almost 80 % of cancers in women. Every year almost 130,000 cases of breast cancer are detected in India and according to the Indian Medical Association the situation will get worse.

Rural women are more affected as the cancer is detected at a much later stage. The increase in awareness and education has also resulted in the rise of the cases from 54,000 ten years ago to 130,000 today. Almost 30,000 women would die due the breast cancer every year, which is a sad statistic as breast cancer is not terminal. If detected at early stages can be dealt with effectively. Incidentally October was breast cancer awareness month and a series of events were held in India to take stock of the situation. Overall there were some key reasons why the situation was getting worse in India.

Some of the reasons for increase in the cases detected include

1) Awareness and education

2) Late marriages and pregnancies

3) Use of contraceptives

4) Hormonal imbalances

5) Stress and change in life style


Not surprisingly Bangalore has emerged as the breast cancer capital of India. Bangalore has an incidence of 36.6 per lakh cases. Thiruvanathapuram and Chennai follow closely and these figures are also an indication of higher awareness in these cities.

The real challenge is to get women to take charge of their lives and get serious about screening. High risk categories are advised to undergo screening once every 2 years especially after the age of 38. Those in high risk include women who have an incidence of breast cancer in their family.

A good example in news was the extreme step taken by actress Angelina Jolie who got her breasts removed once she realized that she was in the high risk category. Her mother it seems had been diagnosed with breast cancer and she had a 80 % chance of developing the condition herself.

So what can we do as a nation?

In the next part of this series I will discuss what can the various parts of the healthcare ecosystem do to combat breast cancer in India.

As always views, suggestions and comments are welcome.


Healthcare Delivery Healthcare Technology

Philips Healthcare India receives Frost & Sullivan Award


Frost & Sullivan recently announced the winners for the Healthcare Excellence Awards 2013. I was delighted to see my good friends from Philips Healthcare  recognized as the Imaging company of the year 2013 at a glittering function in Mumbai.

The awards are given away every year and were instituted in 2009. Incidentally the last two years the award has been won by Siemens Healthcare and this year the Dutch giant has pipped the German Healthcare player.

Philips has been betting big on India and I have seen on my visits to the Philips Innovation Center at Bangalore, some amazing work done by the local teams. Last year I had met some Philips Healthcare leaders like Srinivas Prasad and Ravindra Gandhi as they showcased their critical care solution built for India.

Also was there last week when they demonstrated their new AED which they are suggesting as a’Must have’ for all public installations.

In my opinion Philips is taking the right approach, looking at their product portfolio in the developed markets, bringing in select products among them and re-engineering them to suit the Indian conditions. Also the investment in scientific and technical man power in India has been one of the key success factors for the organization.

Here’s wishing them many more awards..


Healthcare Delivery Public Health

How to survive an heart attack ?

Recently I visited the Philips Innovation Center in Bangalore. While talking to Dr Mabel who had come there to give a demonstration of the lastest Philips Automated External Defibrillator (AED) I came to know of some interesting facts.

Did you know that 7,00,000 people have heart attacks in India each year. and out of them only 10 % survive? This is because a patient needs to get to the hospital within an hour of the initial cheat pain.

Artificial defibrillation just at the moment the heart stops beating can revive almost 80-85 % of the patients. For more on the visit and the demo, please watch my vidoe from the center above.

As always comments and suggestions are welcome.

Healthcare Delivery Public Health

Shot through the heart: What is the Government doing to screen for heart diseases

Cardiovascular diseases continue to be the scourge of India. As discussed in my earlier post, India has probably the largest pool of heart patients in the world, today. The number of heart patients today stands at around 45 million India. So in the run up to the world heart day, on the 29th of September I am doing a three part series on the heart issues in India. The post you are reading is the second part. If you want to read the first part please click here.

So the natural question is what is the Government doing about it ?

To get the answers of this question and many others like this, I spoke to Mr Amol Naikawadi Joint managing director at Indus Health Plus and a member of the CII sub-committee on healthcare.

Amol has been running preventive health initiatives in Pune and the state of Maharashtra and he gave me a very interesting insight to the problem. Some of them are shared below

Insight 1- Gender and location may play a part but the gap is coming down rapidly

According to him heart problems affect all sections of society. But interestingly though earlier men were more affected than women, today the gap has narrowed down considerably. Also there is no clear demarcation between urban and rural Indians when it comes to cardiac ailments.

Insight 2- Heart problems are industry and job agnostic

Though people think heart problems affect IT and other industries where the role is more sedentary, but increasingly it has started affecting people working in all sectors. It is your life style that determines your risk exposure to cardiac problems.

Insight 3- Younger people are more aware of the situation

Many young people in their 30’s are increasingly coming for preventive health check-ups to organizations like Indus Health Plus. This is due to increased prevalence as well as increased awareness of the problems facing the country.

To counter this issue and to get more people to get into the preventive mode, the Government of India has launched scheme under the National Health Mission (NHM) to cover all those who don’t have access to quality healthcare. The scheme would cover both the rural and urban poor, a good indication that the disease today affects both.

The objective is two fold

  • Awareness & Detection
  • Education on lifestyle and stress factors

The plan was to cover Hypertension and Diabetes both indicators and predecessors to cardiac issues and eventually to cover conditions like cancer. The program is funded by the central government, which has allocated thousands of crores of rupees for the scheme. When launched the paln was to cover 40 crore people but after 2 years only 4.5 crore people have been screened. So obviously the program is running into delay and there are not too many people. In addition to this the NHM already has schemes running to reduce infant mortality rate among the urban poor.

“Though the processes and procedures are clearly laid down in the policy documents, but their implementation as always has led to a lot being desired” reflected Amol.

There are also schemes for those with finances to be given tax incentives under 80 D in order to encourage them to undergo preventive screenings.

Finally families earning less than 1 lakh can also look to Government support for preventive care.

One of the most interesting Government schemes comes from the state of Kerala. They launched a scheme called the ‘Karunya Benevolent Fund’ which raises money from the Kerala State Lottery.

‘Karunya Benevolent Fund is providing financial assistance to under-privileged people suffering from acute ailments like Cancer, Haemophilia, Kidney and Heart diseases and for Palliative Care. The amount for the health scheme is raised through lottery. This welfare measure will be helpful to those who suffer from ailments, the cost of treatment of which are proved to be unbearable to lower and even middle strata of society.’

The income generated through the sale of Karunya Lottery is exclusively devoted for extending financial assistance to the purpose. Karunya Lottery comes out with an attractive structure offering Rs. 1 crore as 1st prize.

Source : Kerala Government Website

For more on this article please click here

So one might wonder if the government is doing so much, what about private sector? What are they doing? For that please wait for the concluding part 3 of the series….




Healthcare Delivery Public Health

Shot through the heart: How heart troubles are complicating the India story

My grandmother always used to tell me that working hard 9-5 and having a good night’s sleep were the secrets of a healthy heart. And she also told me that heart problems were a 60’s thing (people in their 60’s)

Her statement could not have been truer as she remained healthy her working life and dies at the age of 65 as you could have guessed of an heart attack. But times have changed.

Today 30 is the new 60’s.

According to statistics from the WHO, India has the largest cardio vascular burden in the world. 1 in 5 Indians die because of cardiovascular diseases. By 2020 the figure will jump to 1 in 3. Currently there are about 45 million heart patients in India. Obviously this figure is much greater as many in the rural areas don’t have the infrastructure to detect heart ailments.

There are two key reasons why such data has come out in the open.

  1. There is a key shift in mortality due to non-communicable life style diseases. So about 50 years ago while malaria and typhoid would have killed many people, today it is Diabetes, Hypertension and Cardiovascular diseases. So clearly mechanization and urbanization has its own perils.
  2. There is increased awareness and screening.  Many more people have been empowered by the media and other social sites. These people read articles like the one you are reading now and become aware of the situation and proactively reach out to care providers to undergo screening.

A combination of these two factors see’s India as the diabetes capital of the world. Indians have the tendency to develop diabetes a good 10-15 years ahead of their western counterpart. The average Indian develops the condition at the age of 45 years.

As the world celebrates ‘World Heart Day’ on the 29th of September I have decided to do a three part series beginning with this post. The second post in the  series would look at what is the government doing to face the challenges posed by cardiovascular diseases and the third post would look at how the private healthcare sector is working on innovative strategies to counter the issue.

I will be back soon and till then comments and suggestions are always welcome…