Healthcare Delivery Public Health

Is SMS medical prescription the new normal in India?


In the future you might receive your medical prescription via SMS.  Yes that’s what is being proposed by the Madhya Pradesh (MP) government.

To make up for the shortage of physicians and specialists the MP government will be now launching a new system by which patients will receive medical advice from doctors via phone and will receive the prescription via SMS. These SMSes can then be shown at Government run dispensaries to receive free medicines.

Only doctors enrolled in the program would be allowed to dispense consultation via phone and only SMSes from these registered phones would be entertained while receiving requests for free medicines.

In previous posts I had discussed how SMS can be leveraged to help shift the needle on the healthcare scenario in India.

Schemes in Gujrat like EMAMTA extensively use SMS to help expecting and new mothers to help receive medical aid. Also All India Radio (AIR) is using SMS to relay daily news to the rural parts of the country.

So it is not surprising that it is a Government agency that is using this remarkable and cheap technology.

Of course there are chances of mis-use as some people might show false SMSes to get free medicines. More than the plan it is the strategy that has created problems for the Government in the past.


As always comments and suggestions welcome.

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.



Public Health

Did you know that India’s healthcare parameters are worse than Pakistan’s ?


A recent report finally uncovers the truth behind the facade of Indian healthcare prowess. A report by the institute of health metrics and evaluation places India below even counties like Pakistan. The report which was featured in an article by Times of India.

The article led to think what is actually wrong with India. At one end we are an industrialized nation, in the global exclusive club for niche areas like Missile technology and space research. On the other end we have one of the worst heath parameters in the sub continent?

lets look at life expectancy as a parameter. The life expectancy of an average Indian is 65.21 yrs. This is lower than than of an average Pakistani at 65.73. Also it is only ahead of South Africa at 59.9, which is not a surprise as South Africa as a country is ravaged by HIV. Some key numbers are mentioned here.

And did you know that the average Indian male in 15- 49 age group has more chances of dying due to a road accident than his Pakistani counterpart who would die due to TB. Also the average Indian woman in the same age bracket is more likely to kill herself than fall victim to a acute disease.

But still in this country we have more and more money spent on HIV awareness, Breast cancer awareness and all well meaning good intentioned efforts. But the numbers who a different picture. The numbers show that we need to spend money on road safety, using technology to bring offenders to task. And for the women we need more helplines, counselling and helping them find the right balance between career and family.

But not only is this non glamorous but also below the radar. To get more an answers to this question I put up the discussion on LinkedIn. The discussion can be followed here. Some of the best solutions that came up included

  1. Universal healthcare- This concept maybe alien to most in India, but western Europe believes in this. According to this concept, Healthcare is a fundamental right, like the right to vote and every Indian should have access to free and good quality health services. This idea though very ideal would require someone to pay for all the free healthcare. In most cases that someone turns out to be tax payers. So considering the number of tax payers in the country, this is not going to work in the immediate future. Also any government initiative comes with its layers of bureaucracy, especially the IAS. Once they come into the picture, the effort would be well governed but not effective.
  2. Nutrition and Exercise- This is a mush more feasible option. Focusing on Nutrition will definitely reduce our infant mortality rates. But what about road accidents and suicides. But definitely focusing on exercise would reduce our risk for heart attacks and pulmonary diseases. But who decides how much nutrition and exercise would help the Indian population? One possible option could be that the new community medicine professional bill just passed by the health ministry could have all these new professionals who can guide the community through this regimen. It can run in the long term but not in the immediate future.
  3. Health Insurance- The lesser said the better. But Health Insurance is a sure shot way of making sure that healthcare costs go over the roof. Definitely a bad idea.
  4. Private Healthcare- A very efficient idea, but again costs will be high as the main motive of the private sector is to make a profit and they cannot be bogged down with all charity that would come with the coping with health of the diaspora.

So in the end there are no answers for the present.

In the long run and for a permanent solution to this problem, we as a community need to come forward and form our own health initiatives. If every locality opens its community health center, and hires its doctors and staff then the cost of healthcare would much lower.

Let me take an example of an apartment block as a community. If all the residents come together, offer some infrastructure and hire a doctor and measure the improvement in health of the residents vs the cost of providing that care then we could see a change in the way healthcvre is delivered and received by the patients.

Do let me know your thoughts on the topic. I would definitely like to hear your views.


Healthcare Delivery Public Health

Why we need to focus on serious problems like Tuberculosis before tackling more complex problems in India? A few thoughts on World TB day 24th March


TB-res-580x300(Image source:

In India it is cool to start tackling conditions like Alzheimer’s and Parkinson’s disease. Actually most celebrities lend their support to even cooler issues like AIDS. But the biggest killer in India today is Tuberculosis(TB). Almost 1/5th of the global cases according to the WHO occur in India. Of the 2 million Indians that develop tuberculosis almost 8,70,000 have the type that turns infectious and out of those people, almost 330,000 die every year. Compare that to 134,000 people that died in India due to road accidents in 2010, an issue that gets more coverage than the epidemic of Tuberculosis.

So why has TB become such an issue and why has it fallen off the radar of the empowered Indian. Well first and foremost TB affects a strata of society that is usually ignored by all the main stream channels. Secondly the social stigma attached with TB prevents the patient from going public and in some cases he refrains from help as well. Thirdly half the patients are treated by the private healthcare set up where the standards of care are not on lines with the government – WHO prescribed model, hence the private players themselves don’t report these cases.

As of last year TB has become a notified disease, hence any private hospital or nursing home treating TB is mandated by law to inform local health authorities. Now though the Government’s intentions in this move are noble again the social issues would force patients out of the healthcare system and actually not seek any help. The fight against TB is based on the early detection and right treatment of the condition.

The treatment of choice recommended by WHO and followed by Govt of India is DOTS (Directly Observed Therapy- Short Course) which includes

DOTS (directly observed treatment, short-course), is the name given to the World Health Organization-recommended tuberculosis control strategy that combines five components:

  • Government commitment (including both political will at all levels, and establishing a centralized and prioritized system of TB monitoring, recording and training)
  • Case detection by sputum smear microscopy
  • Standardized treatment regimen directly observed by a healthcare worker or community health worker for at least the first two months
  • A regular drug supply
  • A standardized recording and reporting system that allows assessment of treatment results

For more on DOTS please visit this page.

How can we as individuals help with TB?

Well I have a personal story here, one of my colleagues, once came to me with a peculiar problem, his maid had just fainted and collapsed in the middle of the household chores. I had suggested that he take her to a local hospital where they discovered that she had the beginning of onset of tuberculosis. As usual her family had refused to come to her aid and actually shunned her asking her not to come back home. In such a situation I reached out to a govt hospital, whose chief medical officer was known to me. Not only did the govt hospital admit this lady but also they treated her for free and organized a counselling session for her family members.

The lesson from this episode is that TB is curable, it needs to be diagnosed and treated at an early stage. If you do come across a patient who is suffering due to lack of help and treatment, just direct that person to the nearest govt hospital, which is mandated to treat these cases for free. Please note seeking help from a Govt hospital is better than going private in TB cases and this is important point to note.

So on the 24th of March which is World TB day, let us at least make a start in getting this issue out in the open and taking the step in eradicating this disease from the face of the earth. For more on the WHO trategy for TB in India, please read this

In conclusion, the fight against TB has to be fought on two fronts- Medical front and on the Societal front. On the medical front our doctors and health workers are in action, but it is upto us to Galvanise the society and do what is needed.



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.