Ensuring Access To Timely Treatment Of Cancer Patients

With very little percentage of cancer patients having access to comprehensive and timely treatment support, a need to face this issue has arisen. Take a look at the ways in which this issue can be resolved

Dr. Harit Chaturved

 It might seem like a contradiction – that in the field of oncology, we are doing much better than before, yet we have a long way to go. I often feel we have hardly covered any significant ground. Not more than 15 per cent of our population has access to timely and comprehensive treatment support. To add to this difficulty, we are expecting that cancer incidences will double within the next decade, because of demographic profile, life expectancy, growing economy, lifestyle, etc. Are we prepared to face this challenge?

Major issue

A major problem is that a big chunk of our resources are spent on advanced stages of cancer and that too in the last six months of treatment in a patient’s journey. If the same resources are spent on cancer prevention and early diagnosis, it would be extremely beneficial for the patients and society at large. It is heartening to realise that almost 60 per cent of cancer is preventable. Tobacco contributes to more than two-thirds of patients in this segment and the other preventable causes are related to diet, lifestyle, vaccine for cervical cancer, liver cancer, etc. Proper education using IT and mass communication tools, with focus from primary education level onwards, could change the scenario rapidly.

Establishment of diagnostic centres

In early stages, the treatment outcomes are very gratifying, less expensive and there is minimal treatment-related morbidity. The operational cost of such a setup would be less than 5 per cent of operational cost of a hospital. These centres could be attached to nearby larger treatment facilities. Probably lot of diagnostic load from hospitals would also shift. These centres should be well equipped with imaging, endoscopies and biopsy procedures. The SOPs should ensure that more than 80 per cent of the patients are adequately attended in less than 72 hours. No cancer facility is complete without a comprehensive palliative care setup as an integral part, and it’s high time we bring the palliative care program centre stage.

Need for infrastructure

In the last two decades, we have seen dramatic growth in trained manpower and number of comprehensive cancer centres. In fact, in the last fifteen years, these numbers would be more than the total work done in the hundred years before that. There is a need to understand our disease pattern and response to treatment. To execute this, we need the infrastructure for research.

Chairman – Max Institute of Cancer Care
Max Super Speciality Hospital, Saket, New Delhi




Arthroscopic Surgery In India

Dr. Raju Vaishya

Arthroscopic surgery of the joints have come a long way in India over the last 25 years. Growing interest in the learning the skills of arthroscopic surgery has attracted many young surgeons in this field. Until, recently there were only countable arthroscopic surgeons in India, but  it is expected that in near future, there would be a tremendous increase in the trained manpower in this field.

Arthrosocpic surgery is a key hole surgery of the joint, which is now being done for variety of problems in almost all the major joints of the body, especially the knee, shoulder, hip, elbow & ankle. With this endoscopic procedure, there is minimal trauma to the tissues during surgery & it offers an excellent & full view of joint from inside. Thus, helping in accurate diagnosis of the problem & most of these problems can now be treated through the key holes using sophisticated & delicate arthroscopic instruments.

Arthroscopy has revolutionized the understanding & treatment of various joint injuries & diseases. Now, numerous new injury & disease pattern have been found & understood as the cause of problem to the patients. Until now, these problems were not recognized & hence not treated adequately. Other supportive investigations like MRI, CT scan etc have also helped in the diagnosis of joint disorders.

In knee & shoulder injuries, arthroscopy has become a gold standard in the diagnosis & treatment. The most common knee injuries, involve the meniscus (cartilage) & the ligaments (ACL/PCL etc). Not only one can remove the torn portion of the damaged meniscus with arthroscopy, but

It is now possible to even repair the damaged portion in selected cases. Cruciate ligament injuries (ACL & PCL) are very disabling & usually occur in young person involved in sports, when the knee is twisted abnormally. These injuries have almost limited or no capability of healing on its own & hence thos involved get repeated episodes of recurrent instability of their knee. This can be totally corrected by doing arthroscopic reconstruction of the ligament. In a recent study, at Indraporastha Apollo Hospitals by Dr Raju Vaishya & his team, on 110 Indian patients with ACL injuries, it was found that 9 out of 10 these patients have had associated generalized joint laxity & this predisposed them for ACL tears.

The damaged articular cartilage  of the joint surface has no capability of healing & hence if damaged & untreated, lead to permanent damage & early onset of arthritis in that joint. Now, it is possible to grow the cartilage in a tissue culture lab in India also & later applied to the damaged area of the joint (Autologus Chondrocyte Transplantation). This leads to re growth of the normal cartilage & thus prevention of arthritis & need for future joint replacement surgery.

The most common problems related to shoulder joint are instability, rotator cuff tears, impingement & frozen shoulder. All these can now be addressed with day care arthroscopic surgery. Young people are more  prone to have instability of the shoulder joint, leading to recurrent dislocations of their joint. Until now, no satisfactory treatment options were available. But arthrscopic stabilization of these shoulders have changed the scenario with outstanding 95% success rates. Elderly people, on the other hand have more rotator cuff tears, leading to persistent pain, weakness & inability to lift their shoulder above their heads. Arthroscopic repair of the rotator cuff can bring significant relief in pain & improvement in their function. Resistant cases of frozen shoulder, which do not respond to conventional treatments like physiotherapy etc can be treated effectively by arthroscopic surgery.

Other joints which are gaining recognition for arthroscopic surgery are hip, ankle & elbow joints.

Is renowned Orthopaedic Surgeon. He is President, Arthritis Care Foundation & Senior Consultant Orthopaedic & Joint Replacement Surgeon, Indraprastha Apollo Hospitals, New Delhi,He is  President of Indian Cartilage Society, India.

How This Immigrant Entrepreneur Built A $5 Billion Healthcare Company?

I interviewed Shradha Agarwal, the co-founder and president of Outcome Health, the Chicago-based healthcare technology company that earlier this year raised $500 million from investors such as Goldman Sachs and Google at a $5 billion valuation.

Founded in 2006, Outcome Health is building the world’s largest platform for actionable health intelligence at the moment of care.

Today, Outcome Health’s platform has a presence in almost 20% of doctors’ offices in the United States, and impacts more than 580 million patient visits each year.

In our wide-ranging interview, Shradha and I discuss, among other topics, how to transform an idea into a company, the difference between a good idea and a good company, the future of healthcare, what she learned from failure, her favorite business books, where to find the best Chicago pizza, and whether the Cubs can repeat as World Series champions.

Zack Friedman: How did you come up with the idea for Outcome Health?

Shradha Agarwal: Growing up, I had a passion for bringing people and information together.

While in college [at Northwestern], [my co-founder and now Outcome Health CEO, Rishi Shah, and I] learned of technology that allowed for this information to be highly customized and we wanted to leverage this technology in a meaningful way.

We have each had healthcare experiences in our family and saw the immediate opportunity to improve a large and critical industry.

Zack Friedman: How did you take your initial idea and turn it into a company? What steps did you take?

Shradha Agarwal: The first step for us was to validate whether our customers truly felt that pain.

We spoke with hundreds of physicians and patients as well as healthcare product manufacturers and payers to understand the industry dynamics, gaps and opportunities.

Second, we built the first iteration of our product and focused on sales of it.

We received a lot of rejections initially, but in each of those conversations, we asked our prospective customers what would make them sign up. With this feedback, we strengthened our product and started to gain sales traction.

Finally, bringing the first few people in the team in a thoughtful way is necessary – a lesson we learned much later.

Zack Friedman: What did you do to disrupt the patient experience, and how is it now better as a result of Outcome Health?

Shradha Agarwal: Our vision is to provide health intelligence to support every important decision a patient is considering with their physician.

Today, we impact about about half a billion patient visits annually by providing relevant and actionable health information to patients and their caregivers in the most critical moments of care. We have measured a variety of outcomes – increased adherence by patients, driven by greater understanding of their diagnosis as well as treatment options, as well as cost savings resulting from that.

Ultimately, this means an improved quality of life for a patient living with a chronic disease.

Zack Friedman: What does the future of healthcare look like in the U.S.?

Shradha Agarwal: We have the opportunity to personalize healthcare and leverage technology to assist the physician as well as the patient to make better decisions together.

With 18% of our GDP spent on healthcare currently, 80% of which is on chronic disease management, empowering patients to participate in their own health decisions has great potential for reducing the cost of healthcare while improving outcomes for individuals.

At a more human level, technology has the power of automating much of the clinical workflow, allowing patients and physicians to connect with greater empathy and time allocation for these important conversations.

Zack Friedman: You founded Outcome Health with a co-founder, Rishi Shah. Would you recommend starting a company with a co-founder, and if so, what considerations should be given when selecting a co-founder?

Shradha Agarwal: I don’t know whether having a co-founder is a requirement, but I do think a preference for it can build a strong foundation.

Entrepreneurship is a lonely journey and having a partner in the ups and especially the downs can be beneficial.

To find the right co-founder, it’s important to be self-aware of your own strengths and weaknesses as well as your values and goals. The best partnerships are complementary in skills but aligned in goals and the vision.

Meeting a co-founder can be similar to a dating process – there is no one right place to meet them, but speaking with a wide variety of people is helpful to build a mental model of who you’d want.

Zack Friedman: What did you learn from your biggest mistake when building Outcome Health?

Shradha Agarwal: We have several learnings along the way and many from our own mistakes.

The two I’ll highlight is the importance of building the right team from the start – people who have conviction behind the vision of the company, but are also comfortable with ambiguity in a rapidly-changing environment.

We now look for people with a strong work ethic and demonstrate persistence, have grit and resiliency and believe in strong team loyalty.

Our initial mistake was to hire people for their skillsets and/or experience alone.

Second, a more recent realization, is to drive great focus in your organization – it’s empowering for people to make rapid decisions and innovate if there is an alignment on the prioritization of goals.

You can do three things well or do ten things okay – because resources of time, money, mind share and energy are limited.

Zack Friedman: You have spoken publicly about your immigrant experience. Can you tell us more about your immigrant experience and how it has helped define you?

Shradha Agarwal: In my experience, immigration itself is entrepreneurial – to leave behind the comfort of the known to explore uncharted territory.

There is risk and uncertainty built in but also a pursuit of something better. The constraints and uncertainties also build your muscle for resiliency.

This country is also built on an ideal of meritocracy, which attracts the most talented people from around the world.

Zack Friedman: What are your three favorite business books?

Shradha Agarwal: I love reading books and in fact, had that passion since being a little girl that led me to my first business; story for another day.

Recent books that have inspired me are Shoedog by Phil Knight and The Hard Thing about Hard Things by Ben Horowitz. I also love reading biographies of leaders from other fields – such as Phil Jackson’s book, Sacred Hoops.

Additionally, vulnerable conversations with your trusted advisors can help gain deep insights.

Zack Friedman: What advice do you have for an entrepreneur who wants to create the next big thing?

Shradha Agarwal: Instead of looking for an idea for a business, identify a problem that is worth solving – is deeply felt, at scale, and has urgency to improve.

Also, know why you’re signing up for this tumultuous adventure called entrepreneurship.

Finally, when you do envision a solution, make sure you have conviction behind your vision because it will be tested several times along the way.

I also want to highlight the difference between a good idea and a good business – the latter has to have an eventual path to profitability for sustained scaling and growth.

Zack Friedman: What advice would you offer to someone who wants to join a tech startup?

Shradha Agarwal: If you have an entrepreneurial DNA but are not ready to (or have already attempted to) start your own business, working at a tech startup gives you many of the upsides – the autonomy to make important decisions, the opportunity to share something innovative, the ability to collaborate with a team who share your passions, while reducing the pressure to own functions you may not want to – whether that’s accounting, HR, marketing or engineering.

In order to thrive in a tech startup, you must have a strong adaptability to rapid change.

Zack Friedman: You’re an avid traveler. What’s your favorite global destination?

Shradha Agarwal: I was in Amsterdam over Labor Day Weekend and fell in love with the energy, diversity and beauty of the city.

I love traveling and have a hard time picking one destination.

That being said – nothing like home: Chicago is the best.

Zack Friedman: Speaking of home, where’s the best pizza in Chicago?

Shradha Agarwal: Until recently, I’d say Lou Malnati’s, but this new place, Bonci, is the first American location of a Rome-based pizzeria – it’s simply addicting.

Zack Friedman: Congratulations on the Cubs winning the World Series. Can the Cubs win the World Series again this year?

Shradha Agarwal: I have strong conviction – yes.

Zack Friedman is the Founder & CEO of Make Lemonade, a personal finance site with free comparison tools, calculators and reviews to help you make smarter financial decisions and save money.

Source:- Forbes

Image Source:- Firenewsfeed.com

How often does the chat you didn’t expect to have end up being the best conversation of your day?

It might be with a colleague you don’t often get a chance to talk to, the person from another team you never have quite enough time to sit down with, or someone you happen to bump into. Such unexpected conversations can spark ideas, open up new ways of thinking and help solve problems.

To encourage these conversations, Kaleidoscope Health and Care partnered with the Guardian Healthcare Professionals Network to send brown paper envelopes with £100 to five lucky recipients to spend on whatever they liked – as long as it was in the cause of having an unexpected conversation on the theme of health and care.

We startled a few finance departments, which sent incredulous emails enquiring what the envelope full of money was for. Coffees, lunches and train tickets were all options; we didn’t mind. All we asked was that winners spent the money within a month, had fun doing so and wrote us two 750-word blogs about the conversations.

To be in with a chance of receiving an envelope, we asked applicants to blog about their best unexpected conversation to date. We were blown away by the response. Entries came from as far away as Pakistan. Applicants from a variety of professions entered, including occupational therapists, policymakers, GPs and charity chief executives. The resulting blogs covered a host of topics, ranging from elderly care to US politics.

Did these conversations fulfil our aim? We think they did – or at least laid the foundations. Our project revealed that unexpected conversations can take place wherever you are, between people of all ages.

Becks Fisher’s unexpected conversation with a US pharmacist while on the campaign trail for Hillary Clinton led her to think differently about our healthcare system – both how lucky we are to have it but also how fragile it is.

Rhiannon is a pharmacist unlike any I have encountered in the UK. She does dispense medications, and she can help people with weight management, self-limiting illness and flu shots, but that’s not what she spends most of her time doing … For her patients, a prescription isn’t the drugs they will take, it is a wish list of those they might take if they have means to do so.

More than one applicant chose to blog about care for older people. Charlotte Williams, chief of staff for UCLPartners Academic Health Science Partnership, described a conversation focused on thinking differently about how we consider elderly patients.

The best unexpected conversation I had was with a geriatrician I was working with a few years ago. She had the view that no older person she looked after was a single unit. She felt that the best physicians – or any member of the clinical team – knew to treat the unit, to ask as much about the accompanying support as the person … in the chair or on the trolley.

For occupational therapist Melissa Purkis and a nurse, the conversation considered innovative solutions to care.

We talked about the initiative in the Netherlands where residential and nursing homes are pairing up with colleges and universities to provide affordable living spaces for students, in return for the students interacting with the older people. In an age where the disparity between young and old is developing like a gaping chasm, and there are numerous reports about loneliness in both younger and older people, it surely makes sense to counter this.

We learned that an unexpected conversation between Kath Parsons and a Macmillan Cancer Support officer led to the establishment of the Older Peoples Advocacy Alliance, the only national organisation supporting independent advocacy for older people.

When the pair discussed a Macmillan report which found older people are often at a disadvantage when it comes to receiving cancer care, their conversation sparked an idea to recruit older people who have been affected by cancer to support their peers.

Peer advocates walk side by side with older people, providing whatever support is needed, from emotional support to housing, benefits or social care advice, treatment needs, and planning for end of life.

Prof Mah Muneer Khan learned that children can be unexpectedly knowledgeable about hand hygiene, which is promising in a world where there are more than 1.4m cases of healthcare-associated infections at any given time.

Our “Unexpected Fellows” have since had more conversations and blogged the results. We hope they inspire you to think about how you can get more of the unexpected into your everyday.

Anna Howells is a partner at Kaleidoscope Health & Care

Join the Healthcare Professionals Network to read more pieces like this. And follow us on Twitter (@GdnHealthcare) to keep up with the latest healthcare news and views.

If you’re looking for a healthcare job or need to recruit staff, visit Guardian Jobs.

Since you’re here …

… we have a small favour to ask. More people are reading the Guardian than ever but advertising revenues across the media are falling fast. And unlike many news organisations, we haven’t put up a paywall – we want to keep our journalism as open as we can. So you can see why we need to ask for your help. The Guardian’s independent, investigative journalism takes a lot of time, money and hard work to produce. But we do it because we believe our perspective matters – because it might well be your perspective, too.

 I appreciate there not being a paywall: it is more democratic for the media to be available for all and not a commodity to be purchased by a few. I’m happy to make a contribution so others with less means still have access to information.Thomasine F-R.

If everyone who reads our reporting, who likes it, helps to support it, our future would be much more secure.

Source: the guardian

Paper Patch Could Help Diabetics Monitor Sugar Level

Researchers have developed a new paper-based sensor patch that could allow diabetics to effectively measure glucose levels during exercise.

Researchers have developed a new paper-based sensor patch that could allow diabetics to effectively measure glucose levels during exercise. In a paper published in the journal Micromachines, the researchers demonstrated a self-powered, wearable and disposable patch that allows for non-invasive monitoring of glucose in human sweat. This wearable, single-use biosensor integrates a vertically stacked, paper-based glucose/oxygen enzymatic fuel cell into a standard Band-Aid adhesive patch. “The paper-based device attaches directly to skin, wicks sweat to a reservoir where chemical energy is converted to electrical energy, and monitors glucose without external power and sophisticated readout instruments,” said Seokheun Choi, Assistant Professor at Binghamton University, State University of New York. Today’s most widespread methods for glucose self-testing involve monitoring glucose levels in blood,

Conventional measurements, however, are not suitable for preventing hypoglycemia (low blood glucose) during exercise, Choi said. This is because the underlying process relies on invasive and inconvenient blood sampling, causing the possibility of sample contamination and skin irritation with sweat containing various electrolytes and proteins, Choi said. Moreover, the method needs patients to carry many accessories during physical activity, including lancets, alcohol swabs and a relatively large glucometer. “The technique requires a sophisticated electrochemical sensing technique and sufficient electrical energy, which makes the technique difficult to be fully integrated in a compact and portable fashion,” Choi added. Here is expert advice on Ayurvedic treatment for diabetes.

On the other hand, sweat-based glucose sensing is attractive for managing exercise-induced hypoglycemia because the measurement is performed during or immediately after exercise when there is enough sweat to obtain an adequate sample. “The sensing platform holds considerable promise for efficient diabetes management, and a fully integrated system with a simple readout can be realised toward continuous non-invasive glucose monitoring,” the researchers wrote.

Conventional measurements, however, are not suitable for preventing hypoglycemia (low blood glucose) during exercise, Choi said. This is because the underlying process relies on invasive and inconvenient blood sampling, causing the possibility of sample contamination and skin irritation with sweat containing various electrolytes and proteins, Choi said. Moreover, the method needs patients to carry many accessories during physical activity, including lancets, alcohol swabs and a relatively large glucometer. “The technique requires a sophisticated electrochemical sensing technique and sufficient electrical energy, which makes the technique difficult to be fully integrated in a compact and portable fashion,” Choi added. Here is expert advice on Ayurvedic treatment for diabetes.
On the other hand, sweat-based glucose sensing is attractive for managing exercise-induced hypoglycemia because the measurement is performed during or immediately after exercise when there is enough sweat to obtain an adequate sample. “The sensing platform holds considerable promise for efficient diabetes management, and a fully integrated system with a simple readout can be realised toward continuous non-invasive glucose monitoring,” the researchers wrote.
Source: IANS
Image source: Shutterstock (Image for representational purpose only)

What Ails India’s Public Health System?

New Delhi: Four days after his newborn twins were admitted to the neonatal intensive care unit at BRD (Baba Raghav Das) Medical College in Gorakhpur, Uttar Pradesh, Brahmdev, a farmer from the nearby village of Bagadada, realized something was wrong with the treatment being given to his children. He began to panic when he noticed a dip in the oxygen supply to the ailing children—soon after the hospital staff directed him to manually pump oxygen by a ventilation device.

Within a few hours, the 10-day-old boy and girl had died, leaving Brahmdev and his wife Suman shell-shocked. This was 10 August. The farmer couple was not the only mourners in the ward that day. A number of the newborns there had now become part of a heart-wrenching statistic: 30 children dead in a span of two days, believed to be because of a cut in the supply of oxygen cylinders by the vendor the hospital used, over non-payment of dues. Brahmdev and Suman were two among the latest victims of the endemic failure of procurement management in the Indian public health system.

The central government, which has the declared aim of achieving Universal Health Coverage (UHC) by 2022, has failed to maintain a reliable and constant supply of consumables, diagnostics and other technologies, which leads to incidents like mass infant deaths in Gorakhpur.

The healthcare budget remains extremely low in India. The total spending on healthcare in the country makes up just 1.2% of gross domestic product (GDP), even though the government’s Draft National Health Policy 2015 envisages progressively raising public health expenditure to 2.5% of GDP.

Of the budget allocated for healthcare, about 26% is spent on procurement of drugs, vaccines and medical supplies. In 2016-17, the health budget was around Rs33,000 crore. The central health ministry spent Rs8,580 crore on procurement. In 2017-18 the overall budget increased to Rs37,471 crore, while procurement went up to Rs9,742 crore. Health economists say that achieving UHC would require an additional purchase worth Rs24,000 crore.

Already struggling with low budgets, a dearth of expertise and embedded corruption in the layered public procurement system, India’s government hospitals are unable to provide effective healthcare to the poor, who are compelled to turn to them in times of need.

Central procurement

The ministry of health and family welfare procures drugs, vaccines, contraceptives and medical equipment for many programmes such as the Revised National Tuberculosis Control Programme, National Vector Borne Disease Control Programme, Universal Immunization Programme, National Family Planning Programme, Reproductive and Child Health Programme, and National AIDS Control Programme.

The problem arises because health financing is an opaque activity, as money, drugs, vaccines and equipment move from the centre to the states (and vice versa). The inefficiency in the procurement process results in both shortages and wastage. When this happens in the field of health, the results can be disastrous, even leading to deaths that can be avoided. There are further complications: inaccurate quantification, delays in tender decisions, payment delays and inadequate monitoring.

The latest report (2015-2016) of the Central Medical Services Society (CMSS), an autonomous body under the ministry of health and family welfare that handles procurement, supply chain logistics and health sector supplies, disclosed that there are several deficiencies in the procurement of various healthcare items. Though programme divisions interacted with state programme officers on every aspect of implementation, the timely supply of drugs, vaccines and contraceptives remained a major concern at the state level.

The report identified deficiencies in the system of procurement of health sector goods. “There was an absence of supply chain management. There was inadequate supply chain infrastructure and quality control. There is manual collection of data and absence of any credible Management Information System for proper stocking and inventory management. There is inadequate professional procurement expertise in the Health Ministry, and delays in estimation of quantities and in settlement of tenders, leading to delayed supplies. In view of these deficiencies, the supply of vaccines, contraceptives and drugs has been irregular, with excesses in some places and shortages at others across the country, thereby affecting programme effectiveness,” pointed out the report.

Public procurement policy experts say that there is a dire need to have procurement specialists in government hospitals. “There is no public procurement law in India. It is governed by a set of guidelines,” said Girish Bhatnagar, procurement policy consultant at the procurement policy division of ministry of finance. Bhatnagar also consults with the World Bank on procurement policy. “In hospitals which must have procurement experts, doctors have been given the role of procurement officers. A doctor’s sole job is to concentrate on patients and research.”

The 2016-17 annual audit report of the Union health ministry pulled up the central government-run Dr. Ram Manohar Lohia (RML) Hospital in New Delhi for blocking funds and non-utilization of equipment. “The Ministry, without ensuring readiness of infrastructure, went ahead and procured various medical equipment valued at Rs15.93 crore for the Emergency Care Centre in RML Hospital. Two pieces of equipment, valued at Rs2.40 crore, could not be put to use as of December 2015. RML also failed to exercise due diligence in procurement of X-ray film, leading to procurement at higher rates.”

States perform worse

As the infant deaths in Gorakhpur made clear, the functioning of health authorities in state governments is even worse. The Comptroller and Auditor General of India, (CAG) in a June 2017 social sector performance report on Uttar Pradesh, found several irregularities in the procurement of equipment in the past five years. Take BRD Medical College, where the infants’ deaths occurred in August. All the way back in June, CAG found that though BRD hospital had Rs27.38 crore to spend, there was a of 27.21% shortage of clinical equipment and 56.33% of non-clinical equipment against the minimum requirement prescribed by the Medical Council of India. “The parking (not spending) of funds not only violated the financial rules but also deprived patients of adequate healthcare as essential equipment could not be procured on time…,” said the CAG report.

Similarly, the CAG report for 2014-15, tabled in the Delhi Assembly in June 2016, criticized Delhi’s health department, arguing that a comprehensive procurement policy for medical equipment was lacking. The report found a delay of up to two years in procurement and delivery of medical equipment. The situation in the supply of medicines, vaccines and contraceptives across the country is no different.

“We are in constant consultation with the states to improve procurement systems in healthcare,” said Sudhir Kumar, joint secretary in the economic advisory department of the central health ministry. “We are attempting to introduce e-tendering across the country, and direct transfer of payment into the bank account of the vendor or service provider to maintain transparency and avoid delays in service delivery.”

Lack of transparency

The health ministry has identified the problems in procurement management; but it has not been able to find a solution due to the complexity of the existing system.

“The procurement of various items, ranging from medicines to medical devices and services, is done in various ways which are not linked with each other,” said a senior official in the health ministry who requested anonymity.

At the state and district levels, procurement of various services is under the National Rural Health Mission. The ministry procures some services directly. In addition, different government hospitals have their own procurement systems, through open tender, rate contract and emergency procurement.

“Some departments procure medical items, vaccines, drugs and services through a procurement agency that charges 2% commission,” the official cited above explained. “There is often overlap, because there are different programmes running for the same diseases, such as vector-borne diseases, HIV, tuberculosis, for which medicines and testing kits are procured. The major problem is that nobody keeps a tab on the stocks in hospitals and programmes. There is a lack of transparency about who is procuring what. There are delays in payments and delivery to states. There have been cases where payments and delivery of essential items and services has taken anywhere between six months and one year.”

“Transparency should be maintained in financial processes,” said Dr Raj Panda, additional professor and senior public health specialist at Public Health Foundation of India. “Introduction of a functional and online MIS (management information systems) can help in tracking the drugs and their timely storage across various warehouses. This contributes to strengthened and well-regulated procurement procedures. Robust data management systems should be in place to track inquiries regarding smart cards, payment approval, patients’ records and utilization rate.”

Learning from the best

In a bid to eliminate inefficiencies in procurement, CMSS officials recommend setting up a central procurement agency along the lines of the Tamil Nadu Medical Services Corp. Ltd (TNMSC), which has performed well in the last 15 years. Some other states, such as West Bengal, Madhya Pradesh and Kerala, also have procurement models that are considered best-in-class.

Tamil Nadu follows a centralized offline procurement system to purchase essential drugs, specialty drugs, surgical items, sutures, veterinary drugs and equipment. TNMSC acts as a mediator, negotiating prices. The government of Tamil Nadu sanctions a specific annual budget, with no provision of advance payments. The payment is made after half the ordered quantity is received. Equipment is only paid for after the purchased item is installed properly at the required premises. All payments are made online.

All branded drugs are procured centrally, through direct negotiations with the manufacturers. These negotiations are based on current market prices and quoted rates. Essentials drugs are supplied free of cost to all public healthcare facilities, while other drugs are sold at subsidized rates through centres at government health institutions.

Kerala Medical Services Corp. Ltd (KMSCL) is yet another efficient procurement system, with a coherent decision-making structure and strict regulatory systems. “Transparency and quality assurance are central to the procurement mechanism under KMSCL,” said Panda. “An efficient procurement mechanism is further supported by e-tenders. There is a competitive and transparent bidding process, strict quality assurance procedures, efficient drug distribution management, periodic evaluations and a reliable financing mechanism.”

Madhya Pradesh Public Health Services Corp. Ltd is a public corporation that acts as the central procurement agency for essential drugs and equipment for public healthcare institutions in the state. The company is also entrusted with setting up and running medical and paramedical ancillary facilities such as hospitals, pathological labs, diagnostic centres and X-ray facilities.

The West Bengal government saved more than Rs706.34 crore by adopting a fair procurement system in 2014 that included free drug facilities, a fair price medicine shop, free diagnostic facilities and dialysis services. It did so through a public-private partnership. A dedicated Web-enabled software, Store Management Information System, was introduced to generate procurement orders against fund allotments. Manual processing of orders and bills has been disallowed in the state.

The World Health Organization advocates “strategic purchasing” to improve the performance of health systems through effective allocation of funds to healthcare product and service providers. It entails deciding which healthcare interventions need to be purchased given population needs, national health priorities and cost-effectiveness.

The Association of Indian Medical Device Industry (AIMED) has been urging the government to move away from so-called L1 procurement, under which the supplier who quotes the lowest price is given a contract. It wants preference to be given to indigenous suppliers who use higher domestic content in their products and recommends penal action against those with a poor delivery record.

Indian Certification for Medical Devices, quality assurance certification from the Quality Council of India and design India certification from the department of industrial policy and promotion should be used as the criteria for deciding who gets a contract.

“Major lapses in the procurement policy of most of the state governments are due to separate funding allocation for different medical colleges/hospitals due to which medical colleges and hospitals have to call for local tenders as well as for local purchases, depending upon the availability of the funds,” said Rajiv Nath, forum coordinator at AIMED. “This usually encourages a system which is non-transparent and many times more favourable for a few suppliers, which may compromise patient safety and health.”

To avoid incidents like the mass infant deaths in Gorakhpur, hospital authorities should make sure they have specialists to periodically assess the medical supplies they require and procure them in time, said procurement policy consultant Bhatnagar.

source:- liveMint E Paper

What Are Different Cosmetic Surgery Procedures Done In India?

  Dr. P. K. TALWAR

The procedures of cosmetic surgery are mainly focused on enhancing a patient’s appearance. Improving aesthetic appeal, symmetry, and proportion are the key goals. Cosmetic surgery can be performed on all areas of the head, neck, and body.

Different cosmetic surgery procedures in India are :

1) Facelift: Is a cosmetic procedure that is performed to remove wrinkles, to remove excess skin from the face and provide a more youthful appearance. Tightening of the face is optional depending on its requirement.

2) Tummy Tuck: It is to perform to give the abdomen a tighter and leaner look. This surgery helps to flatten the tummy.

3) Liposuction: It targets a certain part of the body to remove fat and restore its original shape. Liposuction is performed on the certain areas of the body like calves, back, arms, abdomen, thighs, buttocks, chin, and neck.

4) Rhinoplasty: It changes the look of a person by making necessary adjustments and modifications in ones nose. It also helps in proper breathing as it helps in removing structural nasal defects as well.There are two procedures in which a rhinoplasty is performed. In an open rhinoplasty, the surgeon makes an incision on the cartilaginous tip of the nose known as columella to make modifications required whereas the closed rhinoplasty is performed with the help of an endoscope. No incisions are made in case of closed rhinoplasty.

5) Breast Augmentation: It is performed to restore the firmness and shape of the breast. It is executed with help of breast implants. Incisions are generally made inconspicuous as they are done under the breasts or near the armpits or near the nipple. The incision during breast implant also depends upon the kind of breast implant being used, the degree of breast enhancement to be done and your anatomy. The breast implant is inserted and positioned either under the pectoral muscle or directly behind the breast tissue. Incisions are finally closed by layered sutures or sutures.

6) Hair Transplantation: The cosmetic procedure of hair transplantation helps one to restore one’s hair growth and volume even after aging. Hair follicles are extracted from the donor site of the patient’s head. These grafts of hair follicles are resistant to balding which then, with minimal invasion, are transplanted to the bald scalp.

7) Body Lift: A body lift is a procedure that sculpts the patient’s body into a perfect form. It tones and tightens the skin, tissues, and muscles of various areas in the body to give a youthful look. The procedure of body lift involves circumferential incisions, especially to tighten and tone the lower body constituting of abdomen, waist, groin, thigh, and buttocks. The procedure gets rid of the excess fat and skin in the body. Body lift also involves other procedures to provide the perfect structure and contours to the body.

8) Eyelid Surgery : An eyelid surgery is performed to reduce the lump from the lower eyelids and excess skin and wrinkles on the upper eyelids. Incisions are made on the natural lines of the upper eyelids to separate the skin from the tissue beneath it. Excess fat and skin are removed and the incision is finally closed with very small sutures. For the inner eyelid, the cosmetic surgeon either makes the incision inside the lower eyelid or on the eyelash margins. The extra skin, loosened muscles and fat are then removed.

 Is one of the leading cosmetic and plastic surgeon in India. Since 1996 he has been running Cosmetic Laser Surgery Centre of India. He was also associated with the Indraprastha Apollo Hospitals, New Delhi (India) as a Senior Consultant, Cosmetic Surgeon. His clientele includes Top Models and Film Stars from neighbouring countries, Sport Stars and a lot of foreign tourists.

Effects Of Diabetes On The Oral Health

Dr. Priyanka Goyat

Diabetes is a dangerous health issue that arises when the human body starts losing or has completely lost its ability to process sugar.  One can either be afflicted with Type I of diabetes or Type II of the same, but once caught hold with any of them the functioning of human body starts degrading.  This degradation can affect any body organ, especially the eyes, kidneys, hearts, gums, and nose in particular and soon turns them into a complete disaster. According to the recent National Family Health Survey-4 conducted by the health ministry of Government of India, around 20.3 per cent people from the overall country’s population are afflicted with diabetes.

Several research works and surveys have further predicted that diabetes will soon become an epidemic if not handled with acute precaution and seriousness as the number of its patients is rising at a very fast pace of 30-50% increase each year. It is most commonly observed that the first signs and symptoms of diabetes occur in the human mouth. So paying adequate attention to the oral health needs to be a priority to ensure timely diagnosis and treatment. Periodontal (gum) disease, tooth decay, a dry mouth, fungal infections etc. are some of the most common oral and dental problems found in with the people already facing the risks of diabetes.

Is Diabetes deteriorating your beautiful smile?

Diabetes enters the human body alarmingly with the dangerously high blood sugar levels that can derogate the entire body- including the teeth and the gums.  Controlling this deadly disease from causing any harm to your beautiful smile is entirely in your hands. Remember, you need to control those steeply moving blood sugar level because the higher the level is, the higher becomes the risk of:

Tooth decay (cavities): The human mouth naturally homes numerous types of bacteria. When an excess of starches and sugars from all the foods and beverages we consume come in contact with these bacteria’s, a sticky film known as plaque forms on the teeth. The acids in plaque deteriorate the surface of your teeth, at times further leading to the irritating and painful cavities. The higher the blood sugar level, the greater becomes the supply of sugars and starches- causing the wear and tear of teeth.

Early gum disease (gingivitis): Diabetes weakens the body’s strength to fight against the bacteria. And, if you are not regular with brushing and flossing, then this will surely land you in big trouble. Because, the longer the plaque remains on your teeth, the more irritating it becomes for gingival (part of the gums around the teeth). This results in gingivitis which causes bleeding and swelling up of the gums.

Advanced gum disease (periodontitis):  The severe most phase of gingivitis is periodontitis, which erodes the soft tissue and bone that support your teeth. Eventually, this leads to complete erosion of gums and jaw-bones which possibly makes the teeth loose and fall. Periodontitis becomes an even more severe issue for the diabetics as the increase in blood sugar level decreases the body’s ability to resist infection and even slows down the healing process.

What are some common Dental Procedures?

Dental procedures are designed to clean, strengthen, and protect teeth against the rigors of daily use and (sometimes) abuse, and to repair damage when possible. Here are some of the most common dental procedures performed today by dental professionals.


Applying composite tooth bonding is a restorative procedure that uses tooth enamel-colored composite resin (plastic) to repair teeth that are decayed, chipped, fractured or discolored. Tooth gaps can also be closed. Unlike veneers, which require laboratory work, bonding is done in the dental office.


A dental brace is a device used to correct the alignment of teeth and bite-related problems (including under bite, overbite, etc.). Braces straighten teeth by exerting steady pressure on the teeth.

Bridges and Implants

Bridges and implants are two ways to replace a missing tooth or teeth. Bridges are false teeth anchored in place by neighboring teeth. The bridge consists of two crowns on the anchoring teeth along with the false tooth in the center. Dental implants are artificial roots used to support replacement teeth.

Crowns and Caps

Crowns are dental restorations that protect damaged, cracked or broken teeth. Dental crowns often referred to as caps; sit over the entire part of the tooth that lies above the gum line.


Although they are no longer handled without pain medication, teeth do still need to be extracted for various reasons. Simple extractions are usually handled by the dentist using a local anesthetic and are a quick, outpatient procedure. More complex extractions (sometimes including the common extraction of the wisdom teeth) may require the services of an oral surgeon and may even require general anesthesia and a brief hospital stay. The most common reasons for tooth extraction is trauma that has damaged a tooth beyond repair or decay that has not been treated early or effectively enough to save the tooth.


Dentures are prosthetic devices replacing lost teeth. There are two types of dentures – partial and full. Full dentures are often referred to as “false teeth”.

Fillings and Repairs

Restorative materials are used to repair teeth, which have been compromised due to tooth decay (cavities) or trauma. Your dentist may use several methods to determine if you have tooth decay such as cavity detecting dye, x-rays and laser fluorescence cavity detection aids. Tooth trauma can be caused by cracked or broken teeth, teeth that are worn from unusual use such as nail biting, tooth grinding (bruxism)  and using your teeth to open things. Different materials can be used to repair teeth, the most common being composite fillings made from a tooth-colored resin which looks and feels like natural teeth. Ask your dentist what material is best for you and specific needs.

Gum Surgery

Periodontal or gum disease is an infection that affects the gums and jaw bone, which can lead to a loss of gum and teeth. There are two major stages — gingivitis and periodontitis. Gingivitis is the milder and reversible form; the periodontal disease is often more severe. In some cases, gum surgery will be required to reverse the effect of the disease.

Oral Cancer Examination

Oral cancer starts in the cells of the mouth, tongue or throat. Oral cancer screening is usually a routine part of a dental examination. In this exam, your dentist will feel for lumps or irregular tissue changes in your neck, head, face, and inside your mouth. Your dentist will also look for sores or discolored tissue in your mouth.

Root Canals (endodontics)

Root canals treat diseases or abscessed teeth. Once a tooth is injured, cracked or decayed, it is necessary to open the tooth and clean out the infected tissue in the center. This space is then filled and the opening sealed.


Dental sealants, usually applied to the chewing surface of teeth, act as a barrier against decay-causing bacteria. Most often, the sealants are applied to the back teeth, e.g., premolars and molars.

Teeth Whitening

Teeth naturally darken with age, however staining may be caused by various foods and beverages such as coffee, tea, and berries, some drugs such as tetracycline, smoking, or a trauma to a tooth. There are various teeth whitening options available, including in-office and at-home bleaching.


Veneers are strong, thin pieces of ceramic or resin material that are bonded to the teeth. Veneers are used to repair chipped, decayed or stained teeth and may help in closing gaps between teeth.

Cardiological Society of India to launch a ‘Heart Attack’ app to guide patients to nearest health care centres

In a first, Cardiological Society of India, a non-profit organisation, on Saturday announced the launch of an app that can help people suffering from heart disease with rapid and accurate information about the nearest health care centres.The app, named “Heart Attack”, would guide patients with real time information about the nearest hospital capable of immediate care. It will also show details of physician or cardiologists.

The app, named “Heart Attack”, would guide patients with real time information about the nearest hospital capable of immediate care. It will also show details of physician or cardiologists.”To help the patients with heart attack, CSI has launched first time a Heart Attack App.

In addition, Delhi CSI is also launching a Heart Attack Registry, which will track these travel times and suggest improvements,” Harsh Vardhan, the Science and Technology Minister, said in a statement.”Heart attacks and cerebrovascular diseases are now number one killer in India,” added Sundeep Mishra, Professor at All India Institutes of Medical Science (AIIMS).

While increased coronary care units and angioplasty in hospitals has helped during incidences of heart attacks, it has been noted that maximum benefit has happened when there is a systematic, organised network right from general physician, efficient ambulance service and advanced heart centres. This saves time, imperative in heart attack cases.

Delhi CSI is also planning to launch such an organised network, through which a patient can be diagnosed early, transported fast to a “Heart Care” enabled hospital to undergo necessary treatments. The app, working on Android OS, will be available exclusively in Delhi from World Heart Day, falling on 29 September.