Smart Villages – key to sustaining the Smart cities project

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

 

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Fortis Hospitals & Quality of Care – You decide

Date of incident : 26th & 28th April, 2014

Place : Fortis Hospital, Vashi , Navi Mumbai 

A patient meets a gastroentologist for a consultation at the above mentioned hospital  . The patient hands over all the reports to the doctor ( including the report, which clearly states that the patient is a diabetic ). The Patient is advised to undergo a colonoscopy and come empty stomach / fasting for 17 hours .. I wonder if a diabetic would be fit to stand after  17 hours of fasting ? This is a clear case of medical negligence where a patient can even slip into hypoglycaemia …. but the doctors at Fortis are not even bothered about this . There is a question mark on the protocols and SOPs followed in such big hospitals 

The patient had to inform the doctor about this lapse and also the facility director , then the same was ‘noted’. When the patient came for the procedure , no one even checked his sugar,  despite it being reported that the patient is a diabetic and is on medication ! The quality of care Fortis is providing to its patients is a serious question mark !

The patient hears another patient’s relative in ICU telling the nurse ;

1. ‘You are such a big hospital and you don’t even have a silicon RT ( Rice tube)’ ? The patients relative had to buy the consumables and provide the hospital as they were not available in the hospital . We heard about these in government hospitals , but this is a first hand account of what happens in Fortis Hospital !

2. A patient was questioning the nurse that ‘Why was he charged Rs.300 more for the same procedure done last week’ and the nurse had no convincing reply for him … Billing systems of this hospital have been questioned many times by patients. My family had pointed such cases in the past and the ‘wrongly charged’ amount was later ‘adjusted’ .  

3. A patient was given another patients file … Privacy of patients is not a worry in this hospital 

4. Patients is charged Rs.50 donation towards Fortis Foundation without being asked whether s/he would like to donate ? When questioned , the cashier says ‘Sorry’ !  Charity or loot by Fortis Healthcare !  Such companies are a shame in the name of CSR ( Corporate Social Responsibility ). 

And , at the very entrance, one notices the big display of NABH accreditation. The advertisement mentions that Fortis Hospital is the 7th hospital in Mumbai to be ‘awarded’ this accreditation ! 

Now certifications are becoming marketing tools, and it is high time that these hospitals declare their ‘success and failure rates’ for all admissions and OPDs . Else, they make treatment worse than the disease, and increase the trust deficit between the patient , doctor and the treatment offered 

Rajendra Pratap Gupta 

President

Disease Management Association of India.

http://www.dmai.org.in


Healthcare will be reformed when BJP comes to Power

Health Services – increase the Access, improve the quality, lower the Cost

India needs a holistic care system that is universally accessible, affordable and effective and drastically reduces the out of pocket spending on health. NRHM has failed to meet the objectives and will be radically reformed. BJP accords high priority to health sector, which is crucial for securing the economy.

The overarching goal of healthcare would be to provide, ‘Health Assurance to all Indians and to reduce the out of pocket spending on health care’, with the help of state governments.

The current situation calls for radical reforms in the healthcare system with regards to national healthcare programs and delivery, medical education and training and financing of healthcare. Our government would focus on the following reforms in healthcare:

  • the last healthcare policy dates back to 2002. India now needs a comprehensive healthcare policy to address the complex healthcare challenges, keeping in view the developments in the healthcare sector and the changing demographics. BJP will initiate the New Health Policy.
  • initiate the ‘National Health Assurance Mission’, with a clear mandate to provide universal healthcare that is not only accessible and affordable, but also effective, and reduces the OOP spending for the common man.
  • Education and Training – Will review the role of various professional regulatory bodies in healthcare and consider setting up an overarching lean body for healthcare. High priority will be given to address the shortfall of healthcare professionals.
  • Modernize Government hospitals, upgrading infrastructure and latest technologies.
  • Reorganize Ministry of Health and Family Welfare in order to converge various departments dealing in healthcare, food and nutrition and pharmaceuticals, for effective delivery of healthcare services.
  • Increase the number of medical and para-medical colleges to make India self sufficient in human resources, and set up an AIIMS like institute in every state.
  • Yoga and Ayurveda are the gifts of ancient Indian civilization to humanity and we will increase the public investment to promote Yoga and AYUSH. We will start integrated courses for Indian System of Medicine (ISM) and modern science and Ayurgenomics. We will set up institutions and launch a vigorous program to standardize and validate the Ayurvedic medicine.
  • Move to pre-emptive care model where the focus and thrust will be on child health and prevention.
  • School health program would be a major focus area, and health and hygiene will be made a part of the school curriculum.
  • Focus on Rural Health care delivery.
  • Senior Citizens healthcare would be a special focus area.
  • Give high priority to chronic diseases, and will invest in research and development of solutions for chronic diseases like obesity, diabetes, cancer, CVD etc.
  • Occupational health programs will be pursued aggressively.
  • Utilize the ubiquitous platform of mobile phones for healthcare delivery and set up the “National eHealth Authority” to leverage telemedicine and mobile healthcare for expanding reach and coverage and to define the standards and legal framework for technology driven care.
  • Universalization of emergency medical services-108.
  • Re-orientation of herbal plants board to encourage farming of herbal plants.
  • Population stabilization would be a major thrust area and would be pursued as a mission mode program.
  • Programme for Women Healthcare with emphasis on rural, SC, ST and OBC in a mission mode.
  • Mission mode project to eradicate malnutrition.
  • Launch National Mosquito Control mission.

Poor Hygiene and Sanitation have a far reaching, cascading impact. We will ensure a “Swachh Bharat” by Gandhi ji’s 150th birth anniversary in 2019, taking it up in mission mode by converging resources and building around jan bhagidari:

  • Create an open defecation free India by awareness campaign and enabling people to build toilets in their home as well as in schools and public places.
  • Set up modern, scientific sewage and waste management systems.
  • We will introduce Sanitation Ratings measuring and ranking our cities and towns on ‘sanitation’; and rewarding the best performers.
  • Make potable drinking water available to all thus reducing water–borne diseases, which will automatically translate into Diarrhoea–free India.

 

Rajendra Pratap Gupta

Authored the BJP Election Manifesto 2014 under the Chairmanship of Dr.Murli Manohar Joshi


Time for a New National Health Policy

DMAI Logo1

 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

CC:

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

Chairperson, UPA

Presidents of all the National Political Parties


Toothpastes & Tooth-powders – Potentially harmful for children

 

 

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Rajendra Pratap Gupta

President

July 08, 2013

Chairman

Hindustan Unilever  / Colgate Palmolive / The Himalaya Drug Co. / GlaxoSmithKline

Mumbai.

 

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;

 

  1. 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.
  2. Mentioning this warning prominently and highlighting it in local language in red color on the packing and the toothpaste tube.
  3. 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.

Yours Sincerely

Rajendra Pratap Gupta 

 

Shri. Desiraju, Secretary to the Government of India, MOHFW.


Healthcare policies in India: Setting the right priorities | Modernmedicare.co.in

Healthcare policies in India: Setting the right priorities | Modernmedicare.co.in.


Healthcare policy of a political party

I was on  a call with a leading political party to discuss the Universal Health Coverage and i raised the following points for them to attend ;

1. Defining the UHC – We need to first define , what is Universal Health Coverage .
2. Focusing on execution – increasing the absorptive capacity on healthcare system – Even 1 % of GDP allocated to healthcare is not being used properly . How will we use 3 % ?
3.  Ideating the UHC model – whether it should be pay for use ( except for BPL ) ? Anything free will be worse than what we have today
4. Using technology including telemedicine and mHealth
5. PPP for healthcare outcomes and delivery

Hopefully , this party will be taking care of these points as well . This is the third political party that has sought my views on its Health Policy

Rajendra Pratap Gupta

http://www.indianhealthcareblog.com