India is a village based economy, as about 68 percent of its population (about 833 million people) live in 6,40,930 villages; the size of the villages varying from a population of less than 100 to about 70,000. Villages are not only the ‘feeder points’ (of providing raw material and manual labour) for urban areas, but are also the majority consumer market for urban industries and hence , ‘Smart Villages’ are essential for sustainability of smart cities project and Make in India. The issue of Smart villages is not about ‘fitment’ but of ‘sustainability’ of the entire economy. Also, when we talk of inclusive growth, villages cannot be left behind, else the growth of the country is not sustainable.
If we look at all the major initiatives of the Modi Government like; the Digital India Mission, Make in India , Swachh Bharat Mission , National Rural Livelihoods Mission, Pradhan Mantri Jan Dhan Yojana and Deen Dayal Gram Jyoti Yojana; all of them dovetail into the ‘Model villages’ / ‘Smart Villages’ mission . The former President of India, Dr. A.P.J. Abdul Kalam had initiated the PURA Project ( Providing Urban Amenities in Rural Areas) to bridge the divide between the have’s and have not’s. All these initiatives clearly indicate that without uplifting villages, India cannot grow sustainably.
Also, let’s rethink on one important future prediction – that by 2050, 60 % of the population will live in towns. I believe that due to the increasing density, pollution and declining quality of life in towns, over the next 20 years, we will see reverse migration starting, i.e. people living in urban and mega metros will start migrating towards hinterland / semi-urban / villages, as these areas will be less polluted and more peaceful and will offer a much better quality of living conditions. We must be prepared for ensuring that the building blocks of managing the living of a modern family are an essential part of the Smart village design as villages will be the main hub of activity in the next three decades.
Building blocks for Smart Villages :
One has to understand that, to make the villages smart, one needs to have the underlying theme of being ‘asset light ‘ & ‘low cost’ and, the over arching theme of digitization. These will be driven by IOT / Sensors. Almost all the challenges in rural areas are an opportunity for deployment of technology as a smart solution. Future of the village lies in adopting ‘idiot proof’, ‘future proof’ and low-cost technologies that can be used and serviced by the residents and can serve them well!
Building blocks of health for Smart Villages :
If 68 % of the population of the country (living in villages) is not healthy, then the growth of the country is at stake. Healthy population is the best insurance against recession and slow growth. We have to ensure that we provide enough options for people to adopt a healthy lifestyle and stay fit to be productive, and for this to happen, we need to leverage technology to its optimum use, integrated seamlessly into the daily life of the residents of the village.
It is expected that in the next 5-7 years, every household will have access to a phone , house , potable water and electricity and road and hence it is good to consider mobile phone as the basic necessity besides food , clothing , water, electricity and shelter. All the services from the government must converge to mobile-based platforms.
For health in a smart village, we need to visualize the following building blocks;
Mobile Electronic health record (m-EHR) is the starting point for health in a Smart village, as without Electronic health record , people cannot deliver healthcare using technology and these electronic health records should not be PC based but mobile based.
Once we have the m-EHR, the next thing we need is a pin-code wise geo tagging of all healthcare facilities and professionals, so that people can reach nearest healthcare provider or professional keeping the golden hour concept as the basis .
Also, one of the major draw back in distant / rural areas is the delay in getting the data and incidence of diseases, and hence, we need live data and electronic event reporting . Live data will not only lead to timely interventions, but also help in demand based supply chain, thereby ensuring appropriate supplies and reducing stock outs
Also, today there are enough point of care, non- invasive diagnostics which can be deployed for Health Screening using mobile platforms . Using these technologies, diseases can be detected on time, leading to appropriate interventions . We all know that tertiary care eats up about 75% of all healthcare costs and major part of the household savings, and hence technology driven POC (Point of care) screening would be the most effective way to manage healthcare from a cost, prevention and outcomes point of view
Also, as long as we focus on the allopathic doctor based healthcare system, we will not be able to address the issue of shortage of doctors in rural areas , and hence , we will need to use technology to its best across the continuum of care. We will need to move from the ‘Golden Hour’ rule of providing critical care in 40 minutes to a ‘Golden minute’ rule of providing health advice over phone in less than four minutes, and this is very much doable. Also, there are enough studies, which prove that, about 65-80 percent of the time, we don’t need a face-to-face consultation with a doctor. Given the fact that majority of the expenditure in healthcare is on infrastructure and salaries, we must empanel practicing doctors to provide services to the rural people and pay them per consultation. This will make healthcare accessible for the population and more affordable to the exchequer.
The next logical building block would be an ePrescription, so that, after the doctor’s tele-consultation with the patient, s/he can send an ePrescription which is digitally authenticated. This will lead to delivery of medicines either though an ATM machine dispensing medicines or routing the same through a local chemist.
I have visited rural areas across the country and found that sub-centres typically cost between Rs.7.00 lacs to more than 14.00 lacs, plus the salaries and maintenance . I think it is time that the government makes a policy to replace sub-centres with mobile health centres – eHealth centres, which can move the direction of healthcare services from the current ‘to the doctor’ to ‘to the household / population’ approach, and moreover, these mobile health centres can also double up as an ambulance as and when needed. Doctors can come from the nearest semi-urban and urban areas, examine the patient, treat them and go back in the evening. This might work better than the sub-centres in one remote part of the village where the patient has to take pains to travel for kilometers to see the so called absentee doctor !
Smart villages have the potential to extensively deploy Digital Tools / IOT, and flip the ‘doctor centric’ & ‘Tertiary care’ model in the coming decade and lead the way for containing the cost of healthcare`
This is a part of the speech delivered at the Vibrant Gujarat summit 2017. Views are personal
Rajendra Pratap Gupta
Rajendra Pratap Gupta
President & Member
Board of Directors
October 27, 2013
Shri Keshav Desiraju
Secretary to the Government of India
Ministry of Health & Family Welfare
Nirman Bhawan, New Delhi – 110108.
Reference: Need for a National Health Policy – NHP
Dear Shri Keshav ji,
I am writing on behalf of the Disease Management Association of India – The Population Health Improvement Alliance. We have been proactively taking up issues with regards to healthcare policy & reforms in India.
On February 01, 2013, when you were appointed as the Health Secretary, people involved with the health sector felt happy that the nation had got its best health secretary! Expectations are running high!
This communiqué is about the need for setting up a team to draft the National Health Policy. Since the last National Health Policy was drafted more than 10 years ago in 2002, a lot of things have changed, like;
- NRHM was launched in 2005 as a flagship program focused on rural health
- RSBY was launched
- Pandemic outbreaks like H1N1 (Swine Flu) have been a surprise and have shaken the world
- Rise of MDR – T.B.
- Increase in the incidence of chronic diseases & the issues related to child health
- Occupational hazards
- High IMR/MMR & MDGs deadline approaching in 2015
Besides, a lot of other developments have taken place, like;
- UID –Aadhaar number for the entire population have been initiated
- Emergence of mHealth & telemedicine
- Newer technological interventions for diagnostics and treatment
- Emergence of Big Data Analytics
- Also that, India is focusing on transitioning the healthcare system to Universal Coverage
- Emergence of innovative concepts, like Disease Management, ACOs (Accountable Care Organizations), HMOs (Health Management Organizations) & Meaningful use.
- Emergence of the prominent role of civil society organizations in healthcare delivery
- Role of social media
The 12th five year plan has often been referred to as the plan for health, and I believe, that it is the right time to set up a committee to draft the new National Health Policy by 2015. Even if the committee is set up in early 2014, it will take at least a year to do the survey and complete the policy and so, most likely, the NHP would be tabled by 2015 and would cover a period of next 10 years (2015-2025).
We are sure that you will consider our request seriously and initiate the process for the new National Health Policy
With best wishes and with warm regards
Rajendra Pratap Gupta
Dr.Manmohan Singh, Prime Minister, Government of India.
Shri. Ghulam Nabi Azad, Union Minister for Health & Family Welfare
Dr.Syeda Hameed, Member, Planning Commission, Government of India
Presidents of all the National Political Parties
Rajendra Pratap Gupta
July 08, 2013
Hindustan Unilever / Colgate Palmolive / The Himalaya Drug Co. / GlaxoSmithKline
Ref: Failure to display properly important information related to potentially poisonous effects of toothpastes / tooth powder on children
I am writing this note on behalf of ‘The Disease Management Association of India – The Population Health Improvement Alliance’.
We have come across a glaring lapse in the manner in which the important information related to the quantity of toothpaste / toothpowder to be used by children is not displayed by your company. The correct quantity should be used and the over usage could be detrimental to the health of the population has not been properly displayed on the packaging. This is a serious issue and cause of immediate concern in the interest of millions of children across the country. I am putting here the message displayed on most of the toothpastes/toothpowders sold in India. It is important to quote here that majority of the toothpastes / powders sold are have fluoride as an ingredient.
- ‘For children under the age of six; use a pea sized amount under adult supervision. Do not swallow. (Printed on Pepsodent made by HUL).
- Keep out of reach of children under 6 years of age. If you accidently swallow more than used for brushing, get medical help or contact poison control. Children under 2 years ask a dentist or physicians (Printed on Aquafresh made by GSK. Of course, I brought this particular pack from U.K. but I guess it would be same for India as well).
- Children under 6 years of age should have adult supervision and use only a pea size amount. Do not swallow (Printed on Colgate made by Colgate-Palmolive).
- Children 6 years and below should have adult supervision and use only a pea-sized amount. Do not swallow. Spit and rinse thoroughly after brushing (Printed on Active Fresh Gel by Himalaya Drug Co.)
It is evident that brushing of teeth daily twice is a message blasted on various media platforms i.e. TV, Radio & magazines every day, but the message (using the right quantity & the potential poisonous effects on the health of children if used more than the size of a pea), which should ideally be put as a warning in bold & red colored alphabets or read out aloud in the TV / Radio is completely ignored in these media blasts.
Also, the message to use ‘pea size’ is put in small alphabets and that too, in English only, It is important to consider, how many Indians would understand ‘size of pea’ keeping in mind the rural & non-English speaking population? This is a serious issue, and I am quite surprised that this has not been raised till date by anyone, and this would have already harmed millions of children across the country.
This amounts to a serious ethical lapse on your company’s part, and conveys lack of seriousness towards the health of the country’s innocent children who are coerced into using tooth paste daily without understanding the harmful effects based on the numerous advertisements blasted on various media platforms.
I also must quote the annual report of the Ministry of Health & Family Welfare, Government of India; “Excess intake of fluoride over a long period of time leads to major health disorders like Dental Fluorosis, Skeletal Fluorosis and Non-Skeletal Fluorosis besides inducing ageing. The harmful effects being permanent and irreversible in nature are detrimental to the health of an individual and the community which in turn has an impact on growth development economy and human resources development of the country” and the Government has started a national programme for prevention and control of Fluorosis (NPPF).
Clearly, business interests of your company have ignored the health issues related to children of this country and this has to be addressed without any further delay.
I would like to hear from you about the action taken in this regard in terms of;
- Immediate warnings to be issued on radio, newspapers and television about the quantity of tooth paste to be used by children and harmful / poisonous side effects.
- Mentioning this warning prominently and highlighting it in local language in red color on the packing and the toothpaste tube.
- Withdrawing the old stocks from the market and replacing them with the new stocks with proper warning.
I am also marking this note to Shri Keshav Desiraju, Secretary- Health, Ministry of Health & Family Welfare, Government of India, for actions that might be needed on an urgent basis & how medical associations like IMA (Indian Medical Association) & IDA (Indian Dental Association) have been endorsing some of these brands might need to be looked into.
In hope of the needful at the earliest possible.
Rajendra Pratap Gupta
Shri. Desiraju, Secretary to the Government of India, MOHFW.
Rajendra Pratap Gupta spoke at the United Nations General Assembly Hall on the issue of NCDs ( Chronic Diseases). This was for the Heads of State Summit on NCDs.
Rajendra Pratap Gupta
President & Member
Board of Directors
Shri Ghulam Nabi Azad
Union Minister of Health & Family Welfare October 10th, 2012
Government of India.
Nirman Bhawan, New Delhi – 110108.
Reference: Empowering people , ‘Pre-emptive care’ model & update on the Government Industry Dialogue
Dear Shri Azad ji,
Hope this finds you doing good.
I attended a workshop for health ministers of NDA two days ago . During the workshop , we also visited a village in Gadhchiroli ( A naxalite area in Maharashtra ). Here, I came across a 7th class failed lady who has been delivering healthcare information and advice in the village for many years on mother and child health, and out of the past five years , the village has been ‘Child death free’ for four years .
This service of the 7th class failed lady makes me believe that time has come to move from, ‘Health for All’ to ‘All for Health’ and under this ,
- Move to a system for self care
- We must come out with a healthcare booklet for all the citizens in regional languages
- Give generic names with prices for medicines ( OTC – Over the country or non-prescription pharma or non-pharma products ) , for common seasonal and acute ailments
- Also, the Government must make this booklet available to all the citizens on its website & as an application in Android / Nokia and other phone operating systems. It is time to empower people to take to primary and preventive care . Healthcare indications with OTC products application must be made mandatory in all languages for cell phones sold in India . May be, MOCIT ( Ministry of Communications & IT ) can take the lead in doing this .
More than 3 years back , I had written in the document titled ‘Healthcare reforms agenda’ (http://www.dmai.org.in/Healthcare_Reforms_Agenda.pdf ) , about ‘mass screenings’ for people, and I am glad that your ministry has accepted it , and has already done over 10 million screenings in the past 10 months , which is really commendable . Now , it is time for India to move from ‘Preventive’ care to ‘Pre-emptive’ care ( till now, I haven’t heard this word used for health ! ).
‘Pre-emptive healthcare’ ( Before teen age ) , starts before the age ( late twenties ), when ‘Preventive care’ starts . It would include ;
- Starting with health screening for children when they turn the age of 10 . Earlier the better ! So that children grow up healthy .
- The screenings will include obesity , blood pressure and diabetes screenings, every 6 months . These checks would not cost more than Rs. 10 a year , but can help in making India the healthiest nation !
- Also, major healthcare problems arise due to deficiency of vitamins A, D & B & Omega 3. We must recommend guidelines for all children to undergo tests for deficiency of these vitamins and Omega 3, and also tie up with national level labs for offering these tests at rates mutually agreed by the Government . I understand that currently , it is difficult to have a test for Omega 3 in India, even if one needs to get it done !
- Also, dental examination and eye check – ups must be made mandatory from the age of 6 years
We should, therefore, focus on drafting the child health guidelines and ensure that these become the basic requirement for school admissions and thus, are enforced nationally.
Lastly , on the Government Industry Dialogue (GID) for Healthcare that was organized by the Disease Management Association of India (DMAI) . I understand that you could not attend due to your pre-occupation, but I did receive the note conveying your good wishes for this initiative. This dialogue was a massive success with 60 CEO’s from the Healthcare sector companies attending the dialogue and was addressed by ;
- Dr.Sam Pitroda , Advisor to the Prime-Minister
- Shri Keshav Desiraju, Spl. Secretary , MOHFW
- Dr.Ashok Kumar – representing the DGHS , Dr.Jagdish Prasad
- Shri. Anil Swarup, Addl. Secretary, Ministry of Labour & Employment
- Dr.K.Srinath Reddy, President , PHFI & Chairman, High Level Expert Group on Universal Coverage
- Dr.Prathap C. Reddy, Chairman, Apollo Hospitals Group;
- Besides CEO’s & Managing Directors of leadings healthcare corporations
Besides , the dialogue was well attended by the media . Details of the deliberations are available on http://governmentindustrydialogue.org
This dialogue showed the keenness from both the sides ( Industry & the Government ) to work shoulder to shoulder to address the key healthcare challenges facing the nation .
Three areas of cooperation have emerged; i.e. adoption of districts under mass screening programs , companies willing to work on secondary prevention program in addition to the mass screening program , IT & mHealth companies willing to provide innovative solutions for managing chronic diseases and program evaluation tools, training front line health workers & Rural health . It would be good if the MOHFW now moves to focused meetings under the Government Industry Dialogue to decide the scope of collaboration specific to each program. I am sure that this will lead to more effective implementation of existing programs . I look forward to your guidance on the same.
Over the next couple of weeks, I will be attending meetings in USA – ‘International Wellness and Chronic Care Symposium’, and in Manila – ‘The Asia Pacific Leadership & Policy Dialogue’, hosted by WHO and the World Economic Forum for digital health . Will update you on the developments
With best regards ,
Rajendra Pratap Gupta
Dr.Manmohan Singh, Prime Minster, Govt. of India.
Dr.Sam Pitroda ,Advisor to the Prime Minister of India .
Shri Keshav Desiraju, Special Secretary, Health & Family Welfare, GOI.
Shri Anil Swarup, Addl Secretary, Ministry of Labour & Employment , GOI
Dr.K.Srinaty Reddy, President , PHFI & Chairman, HLEG- Universal Coverage
Dr.Jagdish Prasad, DGHS, Min. of Health & Family Welfare, GOI.