Author: Dr. Vikram Venkateswaran

Management Thinker, Marketer, Healthcare Professional Communicator and Ideation exponent

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Healthcare Technology Public Health

Is India taking care of its senior citizens

Last week I was at Hyderabad for a conference where the focus was on the elderly. India has roughly 120-130 million citizens above the age of 60, and this number is going to rise further due to better healthcare facilities and greater awareness of health. I also got a chance to visit my aunt, who had just recovered from fluid in the lungs. The whole visit to Hyderabad was an eye-opener for elderly care. I think we have a serious challenge in this space and currently, we have more questions than answers.

During the conference, I spent some time connecting with other healthcare professionals like Varma from Intel Health Innovation Group and Vikas Bhalla from Philips. I also had the opportunity to lead a panel discussion on how technology is helping increase access for senior citizens.

In the panel with me were, Dr. Mahesh Joshi, CEO Apollo Homecare, Vikas Bhalla – Director (Ultrasound,) Philips India and Rajagopal G – Founder CEO, KITES Senior Care. Raj and Dr. Joshi have worked extensively in senior care, both at the hospital level and services. The crux of the discussion was the breakdown of the family system that has led to a serious problem, with regards to caring for the elderly. This is more of a social problem. But it gets compounded by the fact that there is no one to care for the elderly. No one to care includes no one to monitor if they have taken their medicines on time or if they are keeping up their doctor’s appointment.

Also, we just don’t have the right number of qualified people to care for the elderly. Medical and Nursing schools are producing professionals who mostly cater to emergency cases and those that need chronic conditions. We are grossly under-equipped to take care of the physical and mental wellbeing.

To add to this we just don’t have the process in place to take into account, continuous monitoring using wearable devices. Also, there is no structure to incorporate that data into the health data to make the right decisions.

While there are many questions there have been some efforts in this space. A leading hospital in Bangalore is working on a model for remote patient monitoring of senior citizens at an old age home.

Gurgaon based Suvida is another venture in this direction where the Suvida Care Manager accompanies the elderly care recipient to the medical facility, takes detailed notes, including a personalized Visit Summary, and accompanies the care recipient back home, Suvida to become the first end-to-end medical coordination company, with a built-in unified user-first EMR (electronic medical record) system, so users don’t have to depend on individual medical facilities for their records.

While these are all steps in the right direction, the scale is clearly not enough to meet the demands of the nation. So the question to you is, is India really taking care of its senior citizens?

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Public Health

Now an easier way of avoiding UTI for Women

One in two women in India have been or will be affected by UTI (Urinary Tract Infection) in their lifetime. One of the main reasons for this are unhygienic public toilets in India. As it is easier for the bacteria to reach the bladder in women, UTI affects women more than men.

In men with enlarged prostate glands and those affected by diabetes, UTI has been observed as well. Symptoms of UTI range from burning sensation in the lower part of the bladder and specifically while passing urine. It also manifests itself as pain, swelling, and fever. While mostly transient, UTI can spread and cause infection in the kidneys. That makes it a serious condition especially in the case of senior citizens.

A lot of emphasis in the management of UTI goes with prevention including awareness about cleanliness in public restrooms and overall sense of hygiene. Also exercise and drinking enough water can result in lowering the chances of contracting UTI.

Medically UTI is managed with Anti Biotics, with both broad-spectrum and narrow-spectrum antibiotics used to treat the condition. Cephalosporins and Quinolones are the medicines that are the treatment of choice. But the ultimate defense against UTI is prevention. While public campaigns like Swacch Bharat are taking shape the improve the public health and sanitation, these have been concerted efforts from the private sector to raise awareness and reduce instances of infection.

Bangalore based startup Pee Easy is one of the players that has recently launched a product to help women and men to overcome the challenges of UTI. They have used food grade paper to create a contraption that can help women and men to pass urine standing up. This would really help reduce the chances of infection. Pee Easy has been set up with vending machines across malls, hospitals and airports and also available at pharmacies.

Such devices are also useful in medical departments like gynecology, orthopedics, urology, oncology and HIV, pathology (for easier collection of a urine sample (under testing)), and post-surgery. In addition to women, senior citizens can really help in reduction of infections.

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Public Health

The real cost of obesity in India

India has always been a land of plenty. Historically it was a land that controlled almost 25-30% of global GDP. It is no surprise then that ancient texts write about obesity in uncertain terms. As a matter of fact practices like Yoga developed in India as a holistic system for physical and mental wellbeing.

During the colonial rule India suffered and so did the health of its citizens. Obesity was replaced with starvation. The Bengal famine during 1943 was the epitome of what all was wrong with the colonial rule and administration. The situation continued after independence, the PDS and rationing system ensured that food was available but in limits.

But 1991 changed all that. With global liberalisation India was an active market to many of the food companies. Nestle, Unilever, General Mills, among others introduced many of their global successes in the country. The net result combined with the growing purchasing power of the middle class has resulted in an epidemic that affects 5% of the population today. It also lays the foundation for systemic conditions like Diabetes and circulatory conditions like cardiovascular diseases.

According to reports from the Indian Heart Association India carries almost 60 % of the cardiovascular disease burden of the world. In terms of obesity again India sees more instances of abdominal obesity. During research on 22 different SNPs near to MC4-R gene, scientists have identified an SNP (single nucleotide polymorphism) named rs12970134 to be mostly associated with waist circumference. In this study, more than two thousand individuals of Indian origin participated and the aforementioned SNP is highly prevalent in this group. Also, obesity seems to affect women more than men in India. According to research done by CADI Research, Obesity among women seems to go higher with increasing BMI.

So what’s the real economic cost of obesity?

  1. For starters, I think it is not necessary for people to spend to consume more if they are already obese. Consumption of food should be “means to an end” and not the other way around.
  2. Obesity forms the basis of the other two lifestyle diseases killing India- Hypertension, and Diabetes. Just last week a very serious colleague from my office had a stroke, his condition was exasperated due to diabetes and obesity.
  3. Studies in India estimate that, for a low-income Indian family with an adult with diabetes, as much as 20 percent of family income may be devoted to diabetes care. For families with a diabetic child, up to 35 percent of income is spent on diabetes care.
  4. If you have Diabetes for five years you would have spent around Rs 1,50,000 on diabetes treatment only. After 10 years you would have spent Rs 4,00,000 and after 20 years you would have spent Rs 15,00,000. The increase in cost with time is due to the increase in complications.
  5. To add this the direct cost of diabetes is around Rs 1,00,000 which includes the cost of direct consultation with doctors and the numerous tests that have to be performed.
  6. Then there is the opportunity cost. Is it estimated that a loss of Rs 50,000 per annum per individual due to sick leaves?

So essentially we have a interesting situation, where we spend money to consume and then spend again on healthcare services.

So how can we change this around

  1. Get aware of the disease burden. If overweight then start, looking at dedicating 1 hour per day on exercises. Something as simple as walking daily is a good start.
  2. Lose the habits, drinking, smoking, junk food is again adding to the costs.
  3. Get regular tests done, this avoids surprises and helps you plan to cover for the disease burden. At a minimum, you should get HB1ac test done quarterly.
  4. Pick up Yoga, I have been practicing Yoga for the last 5 years and have immensely benefited from the practice

The cost of healthcare is only going to go up. Just remember that steps taken today can reduce the cost tomorrow, whether to act or not is totally upto you.

Sources

  1. https://cadiresearch.org/topic/obesity/global-obesity/obesity-in-india
  2. https://edition.cnn.com/interactive/2017/10/health/i-on-india-childhood-obesity/
  3. https://timesofindia.indiatimes.com/life-style/health-fitness/health-news/What-is-the-cost-of-diabetes-care/articleshow/49843288.cms

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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