• Call Us +91 999-966-8222

22% of Indian adults suffer from constipation : Survey

By Vinod Kumar

New Delhi. A recent survey suggest that 22% of the adult Indian population is suffering from the condition, with 13% complaining of severe constipation. 6% of the Indian population suffer from constipation associated with certain comorbidities.

This Survey highlights the predicament of these ‘silent sufferers’, the cause of chronic constipation and problems associated with it. This survey was conducted by healthcare company Abbott in in association with IPSOS, a global market research firm that surveyed 4,133 respondents across 8 cities – Mumbai, Delhi, Kolkata, Hyderabad, Chennai, Patna, Ahmedabad and Lucknow to understand the seriousness of the issue.

Indian Cricketer, Virender Sehwag said about this survey, “Being an athlete, I know gastrointestinal issues can be the root cause for many other health issues including mental health. If we suffer from gastrointestinal issues, it becomes difficult to focus and perform well on field and in life. Having a healthy gut is key as it allows the body to build a stronger immune system.”Infact, the survey results state that after common cold and cough, constipation is one of the most common self-claimed problems for Indians.”

Kolkata tops the charts with 28% respondents suffering from constipation. The survey highlights that one-fourth of Kolkata sufferers do not indulge in any physical activity and believe in self-medication rather than consulting a doctor. Chennai, which is next in line to Kolkata, has a 34% population claiming to experience extreme pain while passing stools. Delhi, which has 23% respondents suffering from constipation shows the highest number of people consuming outside food along with high intake of junk food. Patna, Ahmedabad, Mumbai, Lucknow and Hyderabad reported lower number of constipation sufferers compared to other three cities in the survey.

Dr Kushal Mital, Coloproctologist, Medicare Hospital, Mumbai, says “The study succeeds in highlighting the issue existing around constipation. One of the key aspects being how people neglect the problem and delay seeking medical help. In fact, constipation can be completely avoided by leading a healthy life style, eating right, embracing physical exercises, having ample of water (1litre / every 20 kg weight) to keep body hydrated. However, anyone can face the issue but it should be managed or treated early to avoid complications later on.”

Dr Ramesh Roop Rai, Professor & Director, Department of Gastroenterology, NIMS Medical College and University, Jaipur, says “The problem of constipation is rising in India, especially in urban population. It is basically due to faulty diet and lifestyle habits. Less water and fibre intake, sedentary lifestyle are very much attributed to constipation thereby affecting quality of life. Moreover, many lifestyle disorders like diabetes, hypertension are also associated with symptoms of constipation. Every physician must be aware of the same and proactively enquire about symptoms of constipation and treat it accordingly.”

Dr. Rashmi Hegde said, “In the healthcare ecosystem, every player has a role to play to improve healthcare – be it the patient or the treatment providers. As highlighted in the study, a large number of sufferers are present across India and almost half of them are not visiting a doctor for treatment.

Key Findings of this survey are :

  1. The eight-city survey highlights higher percentage of constipation sufferers in metros (23%) as opposed to non-metros (19%). Kolkata has the highest number of sufferers at 28%, followed by Chennai at 26%.
  2. Various metabolic disorders are likely to cause constipation. For example, Diabetics are 2.2 times more prone to constipation vis-à-vis nondiabetics while patients with Hypothyroidism are 2.4 times likely to develop constipation vs patients without hypothyroidism. Moreover, people with Anorectal disorders have more than 2.7 times the likelihood of associated constipation. Constipation tends to be more severe when associated with some of these comorbidities.
  3. Pregnancy was found to be a common cause of constipation in women, with every 1 in 4 pregnant females (25%) suffering from constipation. It has been observed that constipation is most common in the second trimester. The survey also highlights the fact that 18% pregnant women developed anorectal disorders, thus making it imperative for medical practitioners to identify the condition in its early stage and begin treatment.
  4. Practices like irregular eating habits, consumption of junk food and less water intake have been identified as key factors causing constipation. 21% sufferers do not indulge in any physical activity, making sedentary lifestyle an important factor associated with constipation.
  5. The survey also brought to light the fact that though 88% of the sufferers are concerned about the condition, very few are willing to discuss it with their immediate family or friends due to the “social taboo”. According to the survey findings, 49% of the respondents have been shy about seeking medical help to solve their problem. In fact, on an average, respondents admit to waiting for an average of four months before deciding on consulting a doctor.
  6. A glaring 33% of the sufferers have never treated constipation, while 48% have resorted to home remedies to treat the condition.


Be cautious, Sleep Deprivation Leads to Erectile Dysfunction!

By Dr. Sandeep Patil

Some people tend to cut down on sleep to make sure other responsibilities, work and familial, are met. The urge to ‘get the job done’ somehow proves to be stressful on the body. Getting the right amount of sleep can do wonders for your health; it plays an important role in reducing stress and also lifts the mood. Lack of sleep is known to have adverse effects on the Brain, Heart, weight and life in general. However, specifically in males, sleep deprivation has been said to cause Erectile Dysfunction.

Getting quality sleep is significant in maintaining Testosterone levels, which is vital in maintaining a man’s erection and sex life. It is proven, that most Testosterone is produced while sleeping; highest levels are produced during REM (deep stages of sleep) sleep. When a man is sleep-deprived, his Testosterone levels drop to as much as 70%. Thus, decrease in total sleep or disrupted sleep can impact sexual function. Studies show that sleep deprivation and Sleep Apnea(interrupted breathing while asleep) cause Erectile Dysfunction in more than 60% of men.

Sleep deprivation is often associated with mood disorders, exhaustion and poor stamina. These factors have an impact on the sexual performance and thus stall sexual functioning and energy. Ejaculation shortfall is also experienced in such situations. Males who are deprived of sleep also tend to be aggressive and intolerable which in turn affects an intimate relationship. Lack of sleep also speeds up the ageing process which obstructs sexual activities.

If one experiences sleep deprivation, seeking medical help or discussing the matter with your partner and your doctor can switch things around. Men who have been treated for such cases have shown improvement in sleep patterns which have progressively enhanced sexual functions. Most men require at least 7-8 hours of sleep for testosterone to be produced; to maintain adequate sexual function it is important to get good quality sleep.

Is a Chief Intensivist and Physician, Fortis Hospital, Kalyan.

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

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.


When Should One Go For A Joint Replacement Surgery?

Dr. Raju Vaishya

When your knee pain is so bad it actually interferes with the things you want or needs to do, the time may be right for a joint a joint replacement surgery. Knee replacement may be an option when nonsurgical interventions such as medication, physical therapy, and the use of a cane or other walking aid no longer help alleviate the pain. Other possible signs include aching in the joint, followed by periods of relative relief; pain after extensive use; loss of mobility; joint stiffness after periods of inactivity or rest; and/or pain that seems to increase in humid weather.

Your physician may refer you to an orthopedic surgeon who will help you determine when/if it is time for knee surgery and which type of knee surgery is most appropriate. Your surgeon may decide that knee replacement surgery is not appropriate if you have an infection, do not have enough bone or the bone is not strong enough to support an artificial knee.

Doctors generally try to delay total knee replacement for as long as possible in favor of less invasive treatments. With that being said, if you have advanced joint disease, knee replacement may offer the chance for relief from pain and a return to normal activities.

If you have been experiencing long term joint pain, lasting more than few days, visiting an orthopedist in time will prove to be beneficial. Depending on your condition, your doctor will make a treatment plan, which will include medications, exercise, physical therapy and a few steps in lifestyle modification. In some cases he may recommend either keyhole surgery or even joint replacement.

People with joint pain need to follow a strict daily routine to keep their condition under control and minimize pain and discomfort. This routine includes a religious devotion to daily exercise, use of physiotherapy and heat therapy to keep the joints mobile and check inflammation as well as using supporting devices such as knee braces and orthotic shoes to ensure comfort. At the same time, it is important to understand that unhealthy habits like smoking and drinking tend to have a further negative effect on arthritic conditions. Most important is to check weight gain as excessive body weight puts greater pressure on the knees and the feet and accelerates damage.

Dr. (Prof.) Raju  Vaishya is President of Arthritis Care Foundation & a Senior Orthopaedic & Joint Replacement Surgeon at Indraprastha Apollo Hospitals, New Delhi. He is also well known for his academic contributions. 

5 Things You Need To Know About Medical Travel

By Jenny Cook

Medical tourism – the practice of travelling to another country for medical treatment – is a huge global industry, although not one that is widely promoted or talked about in the UK.

However, despite this, medical travel does seem to be on the up – with data collected by the Office for National Statistics suggesting that 100,000 Britons interviewed at airports nationwide in 2015 were going abroad for medical reasons. So, is it something more of us should be considering? We caught up with Ugur Samut, CEO and co-founder at MEDIGO, the leading online booking platform for safe medical travel, in order to get a better understanding.

1. People combine treatment with a holiday

Seeking medical treatment abroad can double as an opportunity to visit a country you haven’t been to before, and provides a relaxing environment in which you can focus on your recovery away from the stresses and strains of day-to-day life at home.

“Currently, Thailand is the most popular destination to combine a holiday with various elective (non-essential) treatments because of its high-quality care, as well as its attractiveness as a holiday destination. Another benefit of combining treatment with a holiday is the reduced cost.”

2. Different countries specialise in different medical fields

Some countries are renowned for their expertise in particular medical specialties. For example, South Korea is one of the most popular places for plastic surgery, while Turkey is favoured for eye care. Different nations are therefore are likely to have further, more advanced research into – and experience performing – certain procedures.

3. Dental implants are the most popular treatment for medical tourists

As more and more people strive to achieve the perfect Hollywood smile, it’s no surprise that the most popular procedure for medical tourists is dental implants.

“The costly nature of dental implants means demand for this particular procedure is primarily driven by people from the US, Western Europe, and Australia who are seeking more affordable options. In Hungary, for instance, a standard implant costs £800 – compared to £2,700 in the UK.”

4. It’s not just for the wealthy

Despite what many people think, medical tourism is not something that is solely for the rich. It is possible to find a procedure at a price point that suits you without compromising on the quality of care.

“The reason, for example, that Hungary is considerably cheaper than a lot of countries for dentistry is because their government excludes it from VAT to encourage tourism to the country. So, you can rest assured that even if you’re on a budget, you can still expect to receive a high a standard of treatment as you would in a more expensive clinic elsewhere.”

According to MEDIGO, patients who seek affordable healthcare destinations are able to find cost savings of 15% to 75% after all expenses (travel, food, accommodations, and treatment) have been paid.

5. Travelling for treatment can reduce waiting time

It might sound silly, but travelling abroad for treatment can sometimes be quicker than waiting at home – especially in the UK, where the NHS is overwhelmed with patient demand. For example, a report from The Patient’s Association found that, in 2015, the average wait time for a tonsillectomy was 108.4 days.

“Choosing to seek treatment elsewhere can significantly lower this wait time – theoretically there is no waiting time. The only delay you are likely to encounter is the logistics of arranging the treatment, travel, and accommodation.”

Of course, medical travel isn’t appropriate for everyone and it requires extensive research. If you are considering seeking treatment outside of the UK, discuss your plans with your GP or dentist, who can advise on the best options for you.


Boost To Health Care In A.P.

CM to lay stone for ₹600-crore AAIMS tomorrow

Chief Minister N. Chandrababu Naidu will lay the foundation stone for Amaravati American Institute of Medical Sciences (AAIMS), a 300-bed private hospital at Ibrahimpatnam on September 7.

The hospital, coming up in an extent of 20 acres, is a ₹600 crore project, whose investors are about 20 Telugu Non-Resident Indians.

Navaneeta Krishna Gorrepati, an NRI doctor, is one of the founders and chairman of AAIMS. Mokkapati Chandra Sekhar is the vice-chairman and Chalasani Mallikharjuna Rao the Chief Financial Officer.

Announcing the project in a press conference here on Tuesday, Dr. Krishna said: “A.P. is left with minimum infrastructure and healthcare services after bifurcation. We, a group of NRI doctors from this region, have decided to establish a hospital for the benefit of the people of Amaravati and the State.”

Three phases

“The hospital will be built in three phases. In the first phase, a 300-bed facility will be built by the first quarter of 2019. In the second phase, another facility with 400 beds will be built in two years after completion of the first phase. Later, a multi-speciality hospital with 500 beds will be built. In future, a medical school will also be set up,” Dr. Krishna said.

Also, in the first phase, five out-patient (OP) centres would be set up in Vijayawada and Guntur, from where patients would be referred to the main hospital.

Online consultation

“The hospital will provide all services at affordable prices. Our aim is to free the people from the clutches of the corporates, who charge exorbitantly. In addition having expert doctors in the hospital, we will have online consultation facility with a network of 2,000 doctors across the world,” he said, and added that as and when required, experts would be contacted online.

“We aim to provide world-class health services in Amaravati so that people from other States also come here for treatment,” he said.

The founders later thanked the Chief Minister and the State administration for extending support for the project.

The foundation stone-laying ceremony will be held at A Convention Centre in the city at 10 a.m.