February 28, 2010

Rural Health - The Prime Focus in Budget 2010

Finance Minister Pranab Mukherjee has mainly focused on rural health in the budget 2010 with allocation for the health sector going up by Rs 2,700 crore to Rs 22,300 crore.

In some good news for the rural population, the minister also said he plans to ask for an annual survey to tabulate the district health profile in rural areas. "The findings of the survey should be of immense benefit to major public health initiatives, particularly the National Rural Health Mission (NRHM), which has successfully addressed the gaps in the delivery of critical health services in rural areas," he said.

The NRHM, which was launched in 2005 by the UPA government, aims to tackle health inequalities in rural areas. 18 states with poor health infrastructure are the main focus of this program.

The NHRM has been receiving regular funding in all budgets since 2005.
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Mixed reaction to Union Budget by healthcare sector

The Union Budget 2010 has been bullish for the healthcare sector. The government increased the outlay to the healthcare sector to Rs. 22,300 crore from Rs. 19,534 crore.

Vishal Bali, CEO, Fortis Hospitals, said that in a budget that provides 46% of plan allocation for infrastructure, not finding healthcare on the agenda of the finance minister takes another year away in bridging the affordability and accessibility gap in the sector. An increase of 14% in the overall outlay for the Health Ministry does not really pave the way for a 1-2% increase in GDP spend by the government on healthcare.

The annual rural health survey for effective spend under the NRHM scheme and the convergence of NREGA with wider health insurance coverage through Rashtriya Swasth Bima Yojana is an innovative step to increase healthcare cover for rural India. The only positive step to help indigenous manufacture of consumables and implants is the import duty waiver for manufacture of orthopaedic implants. It is ironical that the budget provides for investment linked deductions to the tourism sector but does not provide for any impetus for investments made in setting up new hospitals. The call to reform the Indian Healthcare Agenda goes unanswered again in Budget 2010, Bali said.

According to Dr. Amit Varma, president-Healthcare Initiatives, Religare Enterprises Ltd, the increased assistance to the healthcare sector to Rs. 22,300 crore which is 2% of total outlay, up 14% from 2009-2010 and is in line with the increase last year. Because of capacity constraints in public sector, we expect a large part of this investment to be absorbed by the non-government and private healthcare sector. Health Insurance has also been extended to more than 20% of the Indian population that is covered by the NREGA (National Rural employment Guarantee Act) program. This figure represent a potential 200% increase in the penetration of health insurance in India from the current figure of 5% and the move is expected to have a direct positive impact on the demand and quality of healthcare services and the health insurance sector in India. However, there is no mention of categorizing healthcare as an infrastructure service or of any concessions to increase private sector participation and investment in healthcare infrastructure in India, which is disappointing.

According to Rajen Padukone, CEO, Manipal Health Systems, there has been a comprehensive support to revitalize healthcare sector. It is a well balanced budget. Continuing focus on strengthening and supporting the infrastructure sectors, including healthcare should maintain the economy on the growth path. Relaxation of FDI norms may see more international players coming in to India in the healthcare sector. Extension of tax benefits on Contribution to CGH Scheme will improve the contributions to CGHS. This will improve the operation of CGH Scheme substantially.

Rationalization of the duties on medical equipment will make imports cheaper and cost of healthcare delivery to be lower (Uniform concessional basic duty of 5% and CVD of 4% and full exemption of additional duty on all medical equipment). Orthopaedic implants will be cheaper (specified inputs to manufacture orthopaedics implants exempted from import duty). However, we will have to study the impact on the reduction of prices of drugs (reduction in excise duty from 16% to 10% on the goods mentioned in Medicinal and Toilet Preparations Act), Padukone said.

The subsidies on life saving medical equipments and in critical care areas will help hospitals in adopting the technological advances and help save lives. The tax exemption given to only medical equipments could have been extended to laboratories and medical research as well. High-end expensive critical care medicines should also have been considered for tax relief. Further, the concessions should have been considered for allocation for the implementation of software for health care management systems across the country for better healthcare delivery system, said Dr. N. K. Venkataramana, vice-chairman and Neurosurgeon, BGS Global Hospitals.

While the overall Budget is commendable, healthcare was touched upon in the plan allocation for health and family welfare increase pegged at Rs 22,300 crore, up from Rs 19,534 crore. Healthcare has major challenges in combating the three diseases that plague Indians heart disease, diabetes and cancer. The country need a planned intervention in enabling our health system to reverse the ill effects of these diseases, said Dr Pratap C Reddy, chairman, Apollo Hospitals group.

Other significant challenges include severe shortage of health infrastructure and health human resources. “We need to add 100,000 beds each year for the next two decades at a cost of 50,000 crore per year. It would have been helpful if the government had shown encouragement by enabling an investment-friendly environment for this sector,” he said. Finance Minister has touched upon skill development programmes in his budget presentation. The direct health skills gain could exceed 2.5 million per annum, provided the country augment the right environment to encourage health skills by way of education, training and development.

The service tax net being expanded to include health check-ups undertaken by hospitals for employees of business entities, and for health services provided under health insurance schemes offered by insurance companies, may not be advantageous in ensuring better access to healthcare for the common man, besides being a deterrent for the advocacy of preventive health.

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Towards relevant medical education

Basic medical education and training should be tailored to (i) develop appropriate manpower to meet common health needs, (ii) recognise and manage common health problems, (iii) teach critical appraisal of new information to keep abreast of advances, and (iv) ensure ethical practice. The current system falls far short of these objectives. The lack of relevance of medical education in India has been highlighted in medical literature. The World Health Organisation published its recommendations of “Reorienting medical education” (ROME) in 1991, arguing for major shifts in the educational model. Yet, two decades after the proposal, the changes made have been minimal and superficial; training continues to be inappropriate and inadequate for meeting the health needs of the country.

The standards and setting: The pyramid of health-seeking has its base in informal household remedies, traditional medicine and primary care, and moves through secondary hospitals with tertiary care facilities at its apex. The vast majority of patients seek outpatient services in clinics and small hospitals. A small proportion visits — and an even smaller fraction is admitted to — tertiary care centres. The referral patterns of tertiary hospitals make uncommon conditions presenting at these centres appear common with the exotic seeming standard. Since medical colleges in India operate at the level of tertiary care centres, such uncommon conditions are used for educating India’s basic physicians. The medical colleges, modelled on European-American institutions, retain their colonial inappropriateness. A model, with its focus on local reality (for example, as used in Cuba), is probably more suitable.

The curriculum: In India, the medical college setting, with its different specialities, drives the medical curriculum. Systems and areas of expertise are organised into separate departments, each with a narrow focus and circumscribed field. The demands of the specialty, the teachers and the settings are the factors that tailor medical education rather than the needs of the population they are meant to serve. The failure to develop simple and relevant guidelines for the management of common local medical problems implies a reliance on strategies meant for developed countries. While the need for clinically relevant basic science education is often discussed, in reality, the curriculum continues to be loaded with inconsequential detail.

The examination system: In practice, the systems of examinations have a greater impact on the approach of students to education than the curriculum. The tertiary care focus results in the use of uncommon conditions for assessment during clinical examinations. For example, mitral valve stenosis, an uncommon condition, is a standard case for the final clinical examination, while common conditions (diabetes mellitus, hypertension) are never used for assessment. A medical graduate can pass this examination without ever having been assessed on the diagnosis and management of malaria, endemic in many parts of the country.

Knowledge, skill and confidence: Most medical colleges focus on the transmission of information to students. Many new subjects have been added to the curriculum at the cost of basic clinical medicine and surgery. The acquisition of skills and the confidence to apply them are limited. The emphasis is on arriving at a clinical diagnosis, while a hands-on approach to the management of patients is not stressed. Clerkships during the course and exposure to secondary hospital settings are the exception than the rule and, even when present, occur for short periods. Internship is fragmented with brief periods spent in many specialties. The superficial and theoretical approach to patient care makes students less competent doctors. The general population realises this lack of skill and shops for specialist care. Young graduates also quickly appreciate this deficiency and seek postgraduate qualifications in order to acquire clinical expertise. Seeking a postgraduate qualification is a survival strategy for most doctors, rather than a choice based on aptitude or one based on need. The long periods of training, investment and specialisation in urban-based tertiary centres make doctors reluctant and less suited to work in rural primary and secondary health facilities.

Role models and mentors: Young medical students see their seniors as role models and their teachers as mentors. However, even good medical teachers, while emphasising clinical skills and focussing on common conditions that affect the health of the majority of the general population, are seen to pay lip service to these goals by actually practising in tertiary care facilities. Their actions speak louder than their words and their message of clinical care and service to the underprivileged sounds hollow. In fact, the resistance of the majority of the faculty to change the status quo was one of the major reasons for the failure of the “ROME” effort to get off the ground.

Knowledge, data and official policy: Medical professionals in India tend to quote knowledge acquired from the West. Research is often considered a luxury we cannot afford. The lack of involvement of teachers in clinical research on common problems contributes to the lack of local information. Official statistics constantly underestimate the problems on the ground. For example, 3 million cases of malaria per year are reported officially while unofficial estimates put the figure many fold higher. The use of chloroquine prophylaxis for pregnant women in areas endemic for malaria is opposed by the official policy, citing medication resistance based on research data from other countries and from small pockets in India, whereas doctors working in remote areas find such prophylaxis helpful. The official tuberculosis policy recommends anti-tuberculosis medication without nutrition supplementation, when local evidence suggests better recovery rates with the addition of food to the medication regime.

The significant differences between official perception and reality make teaching medicine difficult. Teachers are caught between quoting official statistics and policy and preparing students for examinations rather than preparing them for the ground reality.

THE WAY FORWARD

With capitalistic thought gaining ground, the Alma Ata Declaration “Health For All by 2000” was abandoned, primary health care initiatives were diluted and the ROME programme was not just stalled but also forgotten. The solutions pursued are “add-ons” without evaluation of the current system and its major shortcomings.

Solutions for the absence of skill-based training during undergraduate medical education are postgraduate courses, including family medicine and the master’s course in medicine and surgery. These belatedly correct the lack of skill among undergraduate doctors. The scarcity of doctors to man hospitals in rural India has prompted the recently conceived course, bachelor of rural health care. This option will improve essential services in rural areas but will divide practitioners on the basis of quality and quantity of training. Neither approach will correct the fundamental problem of the absence of the required skill and confidence among new physicians.

The compulsory posting of new physicians to rural health centres will also have a limited impact on health care delivery. The insufficient skill and confidence of these doctors will result in the continuation of second class health care for the rural poor, the underprivileged and the marginalised.

There is a need to revamp basic medical education. Tinkering and cosmetic changes, as attempted over the past few decades, will not have any impact on the quality of basic doctors. Focus on clinical medicine and the transfer of the necessary skill and confidence are essential. There is a need for patient and community-centred medicine and for the dismantling of disciplinary and specialist boundaries during undergraduate medical education.

Training should be set in primary care and secondary hospital facilities, which is crucial to learn about common health problems in the community and to manage them without expensive technological input. Testing of skills required for working in primary care and in secondary hospitals, rather than the practice of assessing theoretical knowledge of uncommon disorders, is mandatory for success. Physicians with skills to manage common problems in the community will make good general practitioners, be ideal gatekeepers for referral to specialists and follow up patients with the help of advice from tertiary care, consequently becoming the mainstay of the system.

The current approaches to undergraduate medical education do not meet the challenge of managing the basic health needs. Unless fundamental course corrections are made, undergraduate medical education in India is bound to flounder and produce doctors who lack the skill and confidence to manage common diseases and illnesses in the population. The imperative is to re-work medical education and to re-orient training to make it relevant to meet the health needs of the country. The system needs to struggle and transform itself with better and appropriate science and more humanity to make it responsive to societal needs.

(Professors Seshadri and Jacob are on the faculty of the Christian Medical College, Vellore.)

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February 27, 2010

High court warns against use of ‘Dr’ without valid medical degree

Putting a pause to the tug-of-war between physicians and physiotherapists over the use of the prefix ‘Dr,’ the Madras High Court has asked the authorities to take action against persons who use the prefix in their prescriptions and advertisements without a valid medical degree.

Passing orders on a writ petition filed by the Indian Medical Association’s Quackery Eradication Committee, the first bench comprising Chief Justice HL Gokhale and Justice KK Sasidharan said the IMA must furnish details of people prescribing allopathic medicines and administering allopathic treatment and using the prefix ‘Dr’ to the authorities.

The IMA wanted the court to consider its two representations to the government, and to initiate criminal prosecution against paramedical technicians, practitioners and physiotherapists who prescribed allopathic medicine and used the prefix ‘Doctor (Dr).’

The government pleader assured the court that the authorities would take necessary action in accordance with law.

The state government had passed an order last year that a physiotherapist cannot use the prefix ‘Dr’ and should not prescribe drugs. However, paramedics and physiotherapists have been maintaining that the use of the prefix ‘Dr’ is more a matter of courtesy rather than adherence to law.

Referring to a similar petition filed in the court by IMA a few weeks ago, the first bench said that on January 5 the court had asked the petitioner to furnish the names of persons who are practising medicine without any valid licence. The court also asked the authorities to take stringent action such persons on receiving any information.

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February 25, 2010

India Will Produce 5,000 More Doctors to Strengthen Healthcare System

Government has cleared 5,000 post-graduate medical seats in 148 state government medical colleges. Even with this new effort the country faces a shortfall of over 6 lakh doctors, 10 lakh nurses and 2 lakh dental surgeons. This scheme will cost about Rs.1, 350 crore on a cost sharing ratio of 75:25 between the Centre and States. This decision will enable India to produce more specialized doctors every year.

Indian doctors working abroad contribute nearly to 5 percent of the medical workforce of their respective countries while India faces a huge deficit in doctors. Though adding 5,000 more seats will not bridge the huge gap, it’s seen as a positive effort taken in the right direction and is appreciated and welcomed by everyone.

The decision to add more doctors will enable our country to have more gynecologists, pediatricians and general surgeons. And also doctors to specialize in pre- and para-clinical disciplines like anatomy, microbiology, physiology, pharmacology, biochemistry, forensic medicine and community medicine. In order to handle these extra students Health Ministry officials have recently amended the PG regulations of student teacher ratio. Henceforth, student teacher ratio will be 2:1 instead of 1:1 to enable medical colleges to increase seats in PG courses.

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February 22, 2010

Deviation from normal practice not medical negligence - Supreme Court

As long as doctors have performed their duties and exercised an ordinary degree of professional skill and competence they cannot be held guilty of negligence, the Supreme Court held on Wednesday. Laying down a set of principles, a Bench said, “Mere deviation from normal professional practice is not necessarily evidence of negligence.”

The Bench of Justice Dalveer Bhandari and Justice H. S. Bedi said: “A doctor faced with an emergency ordinarily tries his best to redeem the patient out of his suffering. He does not gain anything by acting with negligence or by omitting to do an act. Obviously, therefore, it will be for the complainant to clearly make out a case of negligence before a medical practitioner is charged with or proceeded against criminally.”

Writing the judgment, Justice Bhandari said that in complicated cases doctors had to take a chance even if the rate of survival was low. To prosecute a medical professional for negligence under criminal law it must be shown that the accused did something or failed to do something which in the given facts and circumstances no medical professional in his senses and prudence would have done or failed to do. The hazard taken by the accused doctor should be of such a nature that the injury which resulted was most likely imminent.

The Bench said: “A medical practitioner would be liable only where his conduct fell below the standards of a reasonably competent practitioner in his field. In the realm of diagnosis and treatment, there is scope for a genuine difference of opinion and one professional doctor is clearly not negligent merely because his conclusion differs from that of the other professional doctor.

“The medical professional is often called upon to adopt a procedure which involves a higher element of risk, but which he honestly believes as providing greater chances of success for the patient than a procedure involving a lesser risk but higher chances of failure. Just because a professional, looking at the gravity of illness, has taken a higher element of risk to redeem the patient out of his/her suffering which [however] did not yield the desired result, [it] may not amount to negligence.”

Further, “Negligence cannot be attributed to a doctor so long as he performs his duties with reasonable skill and competence. Merely because the doctor chooses one course of action in preference to the other one available, he would not be liable if the course of action chosen by him is acceptable to the medical profession. It is the bounden duty and obligation of civil society to ensure that medical professionals are not unnecessarily harassed or humiliated so that they can perform their professional duties without fear.”

“The aforementioned principles must be kept in view while deciding cases of medical negligence. We should not be understood to have held that doctors can never be prosecuted for medical negligence. As long as the doctors have performed their duties and exercised an ordinary degree of professional skill and competence, they cannot be held guilty of negligence,” said the Court.

In the instant case, Kusum Sharma and others challenged a National Consumer Disputes Redressal Commission order rejecting their plea for a compensation of Rs. 45 lakh from the Batra Hospital and Medical Research Centre in the Capital for the death of her husband R.K. Sharma after a surgery. It was alleged that Sharma died of medical negligence. The Bench said, “The Commission was justified in dismissing the complaint of the appellants. No interference is called for. The appeal being devoid of any merit is dismissed.”

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MCT develops cellular based tele-health suite

Medical Care Technologies has begun the development of a secure cellular based tele-health suite that enables users to easily transmit vital signs data via the cellular network, to healthcare professionals utilizing the Medsuite application.

Tele-Health Suite is a provision of healthcare services using telecommunication technology to provide healthcare solutions over a geographic distance. Cellular access to Tele-Health Suite allows patients to keep their health regime intact, while being mobile at the same time. According to statistics, China's mobile phone usage has been accelerating at a rapid rate in recent years. The nation hit the 400 million subscriber mark in February 2006; it then took 16 months to top the 500 million mark in June 2007 and another 12 months to reach the 600 million mark. Currently, China has over 700 million mobile phone users in its cellular network.

As the global healthcare market slowly changes from a traditional healthcare system to a more modern electronic healthcare system, that utilizes technology through increased usage of electronic health systems like Tele-Health Suite, there will be limited need for the hospitalization and physical movement of patients as well as enriched health system service coverage.

Tele-Health Suite will ultimately decrease hospital visits, thereby decreasing the overall cost of healthcare expenditure. Ning Wu, president of Medical Care Technologies said, "We are of the belief that Telehealth through cellular networks is going to be an important component of the modern healthcare system and will decrease pressure on the existing healthcare infrastructure. We think the Chinese market will witness substantial growth in the near future as a result of an increasing population, increase in life expectancy, increasing per capita income, and the substantial increase in Internet and cellular phone penetration in China."

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Experts in favour of starting 4-yr rural medicine degree BRHS / BRMS

India's plans to introduce a four-year-medical degree in rural medicine has received a roaring thumbs up.

With majority of MBBS doctors refusing to work in India's most far flung and inaccessible areas, the Medical Council of India and Union health ministry's ambitious project -- the Bachelor of Rural Medicine and Surgery (BRMS) -- received support from a host of experts who had gathered in Delhi for a two-day national consultancy.

Most of the 250 experts, vice-chancellors and deans of medical colleges and directors of medical education, agreed to the immediate need of such a cadre, modelled on China's `barefoot doctors'.

According to the Planning Commission, India is short of 6 lakh doctors, 10 lakh nurses and 2 lakh dental surgeons. The country also has a dismal patient-doctor ratio -- for every 10,000 Indians, there is one doctor.

India, on the other hand, contributes to 20% of the world's maternal deaths, 30% of TB cases, 68% of leprosy cases, 23% of child deaths and 26% of vaccine preventable deaths.

What's worse, despite repeated efforts by the ministry to get trained MBBS doctors to serve rural stints -- promising them extra money and a better chance of getting through a post-graduate medical seat -- rural India's healthcare facility remains abysmal.

According to sources, 8% primary health centres don't have a doctor while nearly 39% are running without a lab technician and about 17.7% without a pharmacist.

Out of the sanctioned posts in community health centres, about 59.4% of surgeons, 45% of obstetricians and gynaecologists, 61.1% of physicians and 53.8% of paediatricians are found to be vacant.

Moreover, there is a shortfall of 70.2% specialists at the CHCs.

MCI president Dr Ketan Desai said, "The idea of BRMS is to get students from rural areas willing to work in their hometowns rather than try getting doctors who don't want to live or work in villages. BRMS will not replace but supplement and strengthen the current medical education system."

Dr Desai added, "The idea is to produce medical graduates who will cater to the specific health needs of rural India."

Health minister Ghulam Nabi Azad said, "We have to reduce dependency on quacks by increasing availability of trained doctors. We are facing 50% vacancy in medical colleges in rural India."

MCI has already approved the proposed curriculum of BRMS. Under the scheme, BRMS degree would be acquired in two phases and at two different levels -- Community Health Facility (one-and-a-half years) and sub-divisional hospitals (secondary level hospitals) for a further duration of two years.

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Centre yet to prescribe 'doctor' tag for Bachelor of Rural Health Care (BRHC) grads

While the union government has decided to go with the Medical Council of India's (MCI) proposal to introduce a Bachelor of Rural Healthcare (BRHC) course, it is yet to be finalised whether BRHC graduates will be able to call themselves 'doctors'.

After the two-day meeting held by the MCIconcluded on February 5 in Delhi, it was almost certain that the Union government will give their approval to the programme to ease the dearth of healthcare professionals in rural India.

MCI president Dr. Ketan Desai told DNA: "Officials from the government of India were present at the meeting and they have agreed to consider the MCI proposal to start a dedicated course for rural healthcare, with some minor changes. Now MCI will prepare a final draft and send it to the government for a final decision."

Talking about the course, Dr. Desai said: "The Bachelor of Rural Health Care will be athree-and-half-year course and students who pass their SSC and HSC (science stream) from schools in rural areas only will qualify for admission.

Initially, the course will be started at government hospitals which have a capacity of 150 beds in a district and which do not have a medical college. The hospital will be given Rs15-20 crore for running the course. The strength of the batch would be 25-50 students." However, according to Dr. Desai, it is not clear whether students who pass this examination will be eligible for the 'doctor' tag. Regardless of this, they will be allowed to practice in notified rural areas only.

"As the course is meant to provide better health services in rural India, students passing this course will have to serve in the government's hospitals or health centres for a minimum of three years and after that, if they wish, they can start their own practice. But they will be licensed to practice in the notified rural area only," the MCI president said.

He further said: "As different rural areas in the same state might have different health problems at local levels, we will finalise a basic course structure with essential subjects and some teaching modules can be added or changed according to local health issues."

"MCI will be sending the final draft to the government of India in the next few weeks and the final decision from the centre will come by the end of March.After that it will up to the states when to start this course," Dr. Desai said.

The Medical Council of India (MCI) has proposed setting up of 300 medical colleges to provide education to rural students and deploy them there to provide basic healthcare facilities to villagers.

'There are around 300 districts in our country where there are no medical colleges and we have proposed a medical college in each of these districts,' MCI president Ketan Desai told

Nearly 280 representatives including health secretaries of states, vice chancellors of health universities and directors of medical educations in the states among others attended the programme.

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IMA doctors against Clinical Establishment Bill

Members of the Indian Medical Association (IMA) today voiced their opposition to the proposed Clinical Establishment Bill at the General House meeting held at IMA House in Ludhiana on Sunday. The Bill has been approved by the Union Cabinet and is to be presented in the Parliament for debate and approval. After detailed deliberations, the members rejected the Bill outright as it “violated the dignity of the profession”. IMA president Dr Narotam Diwan said: “The National Council, which is proposed to be the governing body, will be composed of quasi-literate persons drawn from Unani, Siddha, Nursing and Paramedical sections of the profession. Of the total 18 members of the National Council, only two will be medical graduates. If passed, this Bill will open the doors for every unqualified person to get registered in the guise of Yoga, Unani, Siddha, Nursing and Pharmacy branches.”

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February 21, 2010

India to turn out over 145,000 rural doctors

With people-doctor ratio six times lower in rural India in comparison to cities, the central government on Thursday said it will produce 145,000 rural doctors through a truncated medical course designed after the Chinese "barefoot doctors".

"The proposal envisages training persons from rural areas on the basis of merit to equip him or her to primarily, I underline, primarily to work in 145,000 sub centres," Health Minister Ghulam Nabi Azad said here.

Azad said the proposed Bachelor of Rural Medicine and Surgery (BRMS) course, nicknamed as rural MBBS, will be a community based solution to the public health challenges in rural areas.

This course will be of three-and-half-years as against the conventional of five years of training.

The 145,000 health sub-centres, the first medical treatment point for villagers, are now being manned by Auxiliary Nurse Midwives (ANM). Through rural MBBS course, the central government will deploy at least one doctor at these centres. They will also be appointed in some primary healthcare centres (PHCs) to assist the regular MBBS doctors.

He said not recognizing the need for trained medical human resources in rural areas and unwillingness to consider new ideas for addressing it will not help the situation.

There is a visible urban-rural dichotomy in healthcare delivery in India. While urban India has 200 doctors for every 100,000 population, the ratio is one sixth in rural areas.

"Barefoot doctors" in China are trained farmers who help healthcare reach villages where well qualified doctors will not like to settle down.

Though the rural MBBS is a much better system, the idea of rural healthcare through a special cadre was influenced by the Chinese model.

The minister told doctors associations and medical college authorities from all over the country that the course will not compromise the quality of rural health care. "We are not replacing MBBS or specialist doctors."

Emphasizing the importance of quality in medical education and value of trained medical doctors, Azad said huge vacancies in lower level medical delivery points and a surge in emerging diseases was forcing rural folks to visit cities and thus spend a lot of money. This can be stabilized at local level through rural doctors.

Due to physical, social and cultural distance from medical facilities, people tend to depend on unqualified quacks who often provide "irrational treatment". Azad said past neglect cannot be reason for not thinking of innovative solutions today.

"It is not our case to shirk away from responsibility of having trained doctors but idealism needs to be tempered with reality... the existing situation prevailing in rural areas is compelling us to look beyond current solutions," Azad asserted.

The minister also asked the Medical Council of India to put safeguards in place so there is no compromise in quality.

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Workshop to discuss rural doctors cadre

The proposed alternative model for undergraduate medical education to create a cadre of rural doctors will be discussed at a two-day workshop beginning here on Thursday.

The model, mooted by the Medical Council of India (MCI), is to tide over the shortage of trained manpower for rural health care. It envisages the creation of manpower for health care services in the ‘notified rural areas.’

The four-year course including internship has been titled ‘Bachelor of Rural Medicine and Surgery.’ It will be ‘institutional’ in character, conducted through medical schools which will be tagged with government hospitals in the districts where there are no medical colleges as of now.

Addressing a press conference here on Wednesday, Ketan Desai, president of the Council said the proposal will be discussed threadbare with 19 Vice-Chancellors of Health Sciences and deemed universities, deans and principals of all medical colleges, State health secretaries and directors of medical education, in addition to the officers of the Union Health and Family Welfare Ministry.

Union Health and Family Welfare Minister Ghulam Nabi Azad will inaugurate the workshop.

If approved, the MCI proposes to start the course in August. The National Rural Health Mission has a provision of Rs. 20 crore for one medical school in a district where no such facility exists, Mr. Desai said.

The annual proposed intake for the course is 25 to 50 students and the teaching will be modular in character at all levels.

The eligibility for admission will be class XII from ‘notified rural areas’ of the district. Admission will be district-based and the services rendered by the graduates ‘State-based.’

The graduates will be registered by the State Medical Council concerned in a separate ‘schedule’ created exclusively for the purpose.

The registration will be on a ‘year-to-year’ basis for five years, renewable at the end of each year on an appropriate certification by the designated authority. Each medical school will be affiliated to an examining university which will confer a BRMS degree on students conforming to the disciplinary jurisdiction ‘Code of Medical Ethics’ notified by the MCI.

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BRMS no substitute for doctors, feel experts

Lack of doctors and proper health care in rural areas cannot be corrected by compromised health workers churned out by the proposed Bachelor of Rural Medicine and Surgery (BRMS) course feel experts, who add that such degree holders will in no way substitute MBBS doctors, thus denying the rural population a right to good health.

"On one hand the health care in metros and big cities is quite advanced. On the other, rural areas where 60 per cent of the Indian population resides does not even have basic health care (primary care). This gap, however, cannot be filled by compromised health workers in the name of BRMS. It is against the fundamental right of a citizen of India where every one should be provided with quality health care of similar standards at affordable cost," said S Arulrhaj, president of the Commonwealth Medical Association a conglomeration of national medical associations of commonwealth countries.

Ashok Adhav, national president of the Indian Medical Association, said, "Factors like paucity of doctors, low doctor-population ratio (1.62 per 10,000 only), absence of doctors, lack of infrastructure facilities contribute to the absence of proper health care in rural areas. But this situation cannot be corrected by compromised health workers in the name of BRMS. The IMA strongly opposes this proposal."

Former state president of the IMA Devendra Shirole said, "If the service of qualified doctors is denied to the rural population, early detection of complicated disease conditions and appropriate treatment will be hit."

Meanwhile, the 84th Central Council of the IMA said it is committed to the health of rural Indians and also unanimously and strongly objects to the proposal to introduce the BRMS course, which is a compromised MBBS course, to take care of the rural population of India. "As per article 14 of the Indian constitution, all citizens of India are equal, whether rural or urban. The IMA demands that rural Indians be offered the same standard of health care which is offered to urban Indians. We appeal to the Ministry of Health, Government of India, not to dilute the standards of health care for the rural people. The IMA is of the opinion that only an MBBS degree should be the basic allopathic medical qualification in the country," said Adhav.

Arulrhaj suggested, "At least 25 seats need to be reserved in district medical colleges for candidates who will have to work in rural areas of their choice for the first five years, with annual recertifications. After the five years, they would be free to pursue a post-graduation degree, since, by that time, a second lot of rural doctors' will come in."

Adequate allowances, facilities like rural service allowances, proper free accommodation, education allowances for children, vehicle or vehicle allowances, appropriate reservation for education and employment for children, updation of knowledge, facility for interest-free personal loans etc. should be extended to doctors working in rural areas. Implementation of the Bhore committee recommendations of three-tier system of health delivery should also be done, said Arulrhaj.

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Doctors live 10 years less than others: Study

Doctors help people stay healthy and live long but, sadly, their own lifespan gets shortened because of their work. A survey by the Indian Medical Association (IMA) has revealed that the longevity of Indian doctors on an average is around 58-59 years. This is almost 10 years less than the average lifespan of the general population.

The IMA's Pune chapter arrived at this conclusion after an analysis of the association's social security scheme (SSS) for 5,500 doctors from Maharashtra and over 11,000 across the country registered with it.

IMA Pune chapter's president, Dr Dilip Sarda, told DNA that their data of the last five years indicated that the average lifespan of a doctor pointed to an alarming trend.

"An average Indian lives up to around 70 years of age," he said. "But doctors on an average live only up to 55 to 59 years. It has also been noticed that most of the early deaths among doctors are sudden and caused by cardiac arrest."

Dr Sarda further said that, every year, 12 to 15 doctors in Maharashtra and around 30 doctors across the country died before they were 60. Stress, a sedentary lifestyle and lack of exercise were the main causes of death in these cases, he said.
"They tend to become obese and are under great stress," he said. "Most of them are hypertensive and diabetic. These conditions reduce their chances of living longer."

Dr Sarda blamed doctors for their unhealthy lifestyle. Their sedentary and stress-ridden lifestyle took a heavy toll on their health and was mainly to blame for reduced life expectancy, he said.

Link: Original Article

Pharma biggies disclose payments made to doctors

Even as government here is still debating a code with the drug industry to curb unethical practices like freebies and sponsoring exotic trips of doctors, pharma biggies worldwide have started disclosing payments made to physicians, including dollars spent on consulting gigs, clinical trials and even meals.

So money shelled out by companies to doctors for speaking and advising engagements, investigator-initiated research and gifts will also be posted on the companies' web-sites for all to see.

This is part of a revolutionary legislation, 'Physicians Payment Sunshine Act', under which Merck and GlaxoSmithKline (GSK) have already posted public disclosures about payments made to physicians in the last quarter of 2009. World's largest pharma company, Pfizer Inc will also make "publicly available compensation to healthcare professionals for consulting, speaking engagements and clinical trials in the first quarter this year for payments made post July 2009," says Pfizer's director worldwide communications, Kristen E Neese.

The issue has wide ramifications for an industry increasingly facing allegations of kickbacks, payments and gifts paid to influence prescriptions, and has had to pay billions as penalties for marketing drugs for unapproved uses.

The proposed legislation introduced by Senator Grassley is still pending in US Congress. "The objective is to bring in transparency and improve patients' understanding of how the pharma industry and healthcare providers work together to improve patient care," a GSK official said, and for a broader disclosure of financial relationships between the two.

The trend is gathering storm overseas with most companies endorsing the move to disclose such payments on their web-sites. In December last year, GSK disclosed payments made to US physicians and other healthcare professionals for speaking and advising services during April-June 2009.

Merck was among the first companies to endorse the Act in 2008. "As part of our voluntary commitment to increase transparency around all major aspects of business, beginning October 15, 2009, we have started disclosing payments to US-based medical and scientific professionals, who speak on behalf of our company or our products in programmes known as Merck Medical Forums. This is in-line with high ethical standards," said KG Ananthakrishnan head MSD India.

Companies globally have started to shed light on these payments, before the Act is passed under which they will have to make some mandatory disclosures. The disclosures will also include payments made to major academic institutions and research sites for clinical research. While, in India the pharma industry and government believe "in self-regulation".

A code which curbs unethical sales promotion and marketing expenses and bans non-medical and personal gifts has been drawn up by the industry, which is voluntary.

Organisation of Pharmaceutical Producers of India (OPPI) DG Tapan Ray feels that "the goal (of curbing unethical industry practices) will be achieved through the amended Medical Council of India (MCI) regulations". The MCI, which can suspend or even cancel a doctor's licence in case of violation, recently amended guidelines under which all gifts, travel and hospitality to doctors was banned, and participating in medical research and affiliations allowed with certain riders.

Link: Original Article

PG medical race: 2,000 more seats from this year

There is hope in sight for students battling for 'half a seat' in medical colleges or emigrating to Russia to pursue a post-graduation. The Medical Council of India has given the green signal for additional PG medical seats across various states in the upcoming academic year -- an approximate 2,000 seats in all, with Tamil Nadu showing the largest swell, followed by Karnataka, Gujarat and Maharashtra.

At present, in some streams like MD (anaesthesia), a seat for the general category student in some Maharashtra colleges is available once in two years -- in other words, it is literally "half a seat every year" for these student-doctors.

MCI member Ved Prakash Mishra told TOI that the regulatory body had received applications from 45 medical colleges across 12 states. "By March-end, seats in post-graduate medical education will go up by 2,000," he added.

Incidentally, MCI is undertaking this expansion without any inspection -- it is based on the new formula that allows every college to get two PG seats for every professor it has. Earlier, the MCI allowed only one seat per professor; that is, the student-faculty ratio stood at 1:1.

Maharashtra could just be the loser in this expansion spree. Both Tamil Nadu and Karnataka had in the recent past invested hugely in not only setting up new public medical colleges, but also in attracting senior faculty members by offering them competitive compensation packages and permission to practise privately. But Maharashtra has, for several years, suffered from vacant faculty positions and poor budgetary allocation for higher professional education.

"We had asked every college to give us a list of faculty members they have in each subject and we increased their student intake capacity based on the information we received," Mishra added.

Private medical colleges will also undergo similar expansion. But they will have to undergo an MCI inspection before getting the additional seats.

However, students can breathe easy as, by March-end, the MCI believes that the student intake capacity for PG medical seats in the country will stand at approximately 16,500. Already, MCI has sent out sanction letters for 1,600 seats to various state government. Before the expansion process rollout, India had 14,260 seats in the various PG medical streams.

Maharashtra officials said that filling up of vacant faculty positions was the priority now. The state has also informed the MCI that it will in the next couple of years start post-graduate courses in its medical colleges in Kolhapur (which started in 2001), Akola and Latur (both started by the government in 2002). "Once we start PG courses in these three colleges, we will probably have the highest number of seats in the country," said an official.

As of now, with the seat expansion already taken place, the race to make it to a PG course during the admissions season of May 2010 is likely to ease a lot.

Link: Original Article

February 20, 2010

Cabinet clears bill to check medical malpractices

In a move that may help in improving medical services, checking malpractices and sub-standard services to patients, the government has decided make registration of all private, public medical facilities and diagnostic laboratories operating in the country compulsory.

The cabinet on Thursday cleared the Clinical Establishment (Registration and Regulation) Bill that aims at bringing all clinical establishments under a single regulatory framework.

The bill is expected to be tabled in the budget session of parliament. It envisages registering and regulating all hospitals, clinics, nursing homes and labs run by government, trusts (public or private), corporations (including a cooperative society), local authorities or a single doctor.

This means, all clinical establishments would now have to maintain a certain minimum quality standard set down by the National Council for Standards. They would be subject to government scrutiny and rated for their quality, facilities and services. Establishments providing unsatisfactory healthcare can lose licence to operate.

Conditions of registration include having minimum standard of facilities, minimum qualification of health personnel and providing evidence of compliance of the prescribed standards. These establishments will also be open for inspection by authorities. Penalty for non-registration will be an offence punishable with fine up to Rs5 lakh.

A clinical establishment will include hospitals, maternity homes, nursing homes, dispensaries, clinics, etc, and similar facilities with beds that offer diagnosis, treatment or care for illness, injury or pregnancy in any recognised system of medicine (allopathy, yoga, naturopathy, ayurveda, homeopathy, siddha and unani).
It also includes any laboratory (either established as independent entity or part of an establishment), which offers pathological, bacteriological, genetic, radiological, chemical, biological and other diagnostic or investigative services.

With the proposed law, the government expects to crack down on private diagnostic laboratories, especially those engaged in illegal sex determination tests and fraudulent medical practices.

Link: Original Article

Apollo plans 250 Reach hospitals in small towns

Apollo Hospitals, which runs a chain of 47 hospitals in cities such as New Delhi, Chennai, Bangalore and Hyderabad, is eyeing small towns such as Karimnagar as key levers of its future growth.

The hospital group has set up a 150-bed hospital in the tier-III town of Karimnagar, about 162 km from Hyderabad, at an investment of Rs 22 crore.

Offering services to people living in and around Karimnagar, the hospital is expected to achieve margins of 25% in the future.

Called ‘Apollo Reach’ and set up in non-metros and non-urban parts of the country, the 100-150 bed hospitals like Karimnagar are believed to be a high-profitability, low-cost model, according to Suneeta Reddy, executive director, finance at Apollo Hospitals.

“Once the model evolves, we will look at scaling it up. It’s a long-term plan,” Reddy said.

The group is planning to set up Reach hospitals in places such as Nellore (Andhra Pradesh), Bhubaneshwar (Orissa), Karaikudi (Tamil Nadu) and Nashik (Maharashtra), in the near future. The Reach hospital at Karur in Tamil Nadu commenced operations recently.

The Chennai headquartered group has a plan of setting up
a chain of 250 Apollo Reach hospitals across non-urban India with an investment of about Rs 12,500 crore, offering services like cardiology, cardiothoracic surgery, orthopaedics, neurosurgery, emergency and trauma care, amongst others.

Industry experts say the strategy of setting up 150-bed hospitals in semi-urban and rural parts has a huge potential. According to a healthcare analyst with an equity firm, all costs — manpower, land, operations — are much lower in rural parts, than in the cities.

“The salaries paid to medical and paramedical staff in smaller towns is much lower say by 30%, than what is paid in metros and mini-metros. Also, real estate can be acquired at throwaway prices, which reduces project cost by 20-25%. When there is not much invested in terms of land costs, it makes break-even quicker, say in 18-24 months time,” the analyst said.

According to Ankur Bharti, consultant, Technopak (healthcare practice), the rates charged to patients are about 20% lower than what is charged from patients in cities. “This makes healthcare services more affordable.”

According to Reddy, the revenue per bed at the Reach hospital is approximately Rs 3,200. According to Bharti, in the next say three years time, revenue per bed could reach Rs 9,000-10,000.

Apart from the Reach hospitals, Apollo is aiming at adding 500 beds to its current 7,834 beds by end of FY10 and 800 beds each in FY11 and FY12 at an investment of Rs 500 crore.

Link: Original Article

February 11, 2010

Soon, get medical consultancy with SGPGI through video-conference

Long queues at the OPD of Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS) may soon be a thing of the past with the integration of telemedicine and Hospital Information System (HIS) that will allow patients to get medical consultancy without being physically present at the OPD.

School of Telemedicine and Biomedical Informatics, SGPGI, is all set to integrate the tele-consultancy system with an updated HIS. The facility will enable patients to fix up an appointment with the doctor and interact with him through video conferencing during the doctor’s OPD time.

The HIS at SGPGI is being updated to provide a web-based interface to patients. The patients can now access medical data, including test reports and also pay their hospital bills online.

The network has already been updated with a 10G bandwidth for the purpose and software and server for the same have been setup.

Ads by Google Video Conferencing System IP/ISDN/3G Video Conferencing For Enterprises & Service ProvidersRadvision.com/VideoCDoctors UK Work Permit Tier 2 Work Permits for Doctors NHS Jobs, Consultancy Jobswww.CommonwealthContSmartDoc Software For Doctors By Doctors Patient Management SoftwareiSmartDoc.googlepage

“The patients will be provided with a username and password and they can get reports and pay bills online. They can also get in touch with doctors through tele-consultancy either in the OPD or their chambers,” said Dr RK Sharma, Director, SGPGI.

“Tele-consultancy is still not a part of the system at the SGPGI. The integration of telemedicine with the hospital network will allow us take technology to the routine area of the hospital for encouraging participation of doctors,” said Dr S K Mishra, Nodal Officer of the School of Telemedicine and Biomedical Informatics, SGPGI.

Tele-consultancy between SGPGI experts and remote patients started in 2001 but was restricted to the consultancy room of the School.

“Till now, the tele-consultancy with remote patients meant that doctors had to be physically present at the School of Telemedicine at a fixed time. But, OPD being their first priority, it used to be difficult for doctors to spare time for such appointments, because of which the consultancy got delayed time and again,” explained Dr Mishra.

“The integrated tele-consultancy system will be functional in the next six months and will also help in reducing the waiting list of the OPD,” added Dr Mishra.

Repu Daman, network engineer at the School of Telemedicine, said: “If doctors came for tele-consultancy, the patient load at OPD increased and it got difficult to manage both sides. With the facility, patients can fix a time with the doctor during his OPD hours and can interact through tele-consultancy.”

Link: Original Article

Doctors warm up to co-ownership of health care facilities

Rajesh Dave, a specialist doctor, has been running a small clinic in Central Mumbai [ Images ] for over a decade. In the next three weeks, Dave and 35 other doctors will together own an advanced medical centre at Tardeo in Mumbai, with four operation theatres, 20 beds and advanced diagnostic machines.

Their venture, Nova Medical Centre, is part of a new model of day-care medical centres in various parts of the country planned by its founder, Mahesh Reddy, and funded by New York-based GTI Ventures, a venture capital company. Nova will soon open 25 day-care surgery centres in leading cities within the next 20 months.

In this emerging trend, doctors are joining hands with venture capitalists, drug firms and medical equipment vendors to set up advanced medical care facilities at low costs.

While the cost of setting up a quality hospital are as high as about Rs 70 lakh (Rs 7 million) per bed and one has to wait for about five years to get returns, the investment required in this model is about Rs 20-25 lakh (Rs 2-2.5 million) per bed and the return on investment is less than three years. This model has attracted the interest of the investor community, especially venture capitalists, and already a few deals are brewing, say investment banking sources.

About 20 surgeons, who will visit the centre every day for performing surgeries, will together invest about Rs 3 crore (Rs 30 million) in the venture, says Girish Rao, managing director and chief executive of Nova.

"This will be the trend in future, as currently most hospitals are not professionally managed and have limitations in growth when doctors evolve as businessmen. Private equity players are not interested in hospital projects which require Rs 100 crore (Rs 1 billion) investment for a 100-bedded hospital and a wait for five years to get returns," said Muralidharan Nair, Partner-Business Advisory Services, Ernst & Young.

Like Nova Medical, Hyderabad-based Continental Group, promoted by two US returned doctors, is planning to set up about 40 Integrated Hospital Centres (IHC) in and around Hyderabad, with focus on dialysis as a specialty. The doctors are in discussions with private equity companies to raise funds for the project, said sources.

Hyderabad-based MedPlus Healthcare Services, which runs a chain of full-service pharmacies, is currently setting up a chain of Integrated Health Centres across the country. These would comprise a family clinic, diagnostic lab and a pharmacy outlet. Its IHCs will have a physician, paediatrician and a gynaecologist. MedPlus, promoted by a US-returned doctor, Madhukar Gangadi, operates 25 such centres in South India [ Images ].

The centres to be set up by Nova are aiming at 20-25 not-so-complex surgeries in a day, in specialties like orthopedics, ENT, gynaecology and cosmetology. Since complex surgery isn't done, the patient can go home the same day.

"While the chances of hospital inspections are less in this type of hospital environment, the patient is also offered better facilities at comparatively cheaper rates," says Rajesh Dave.

Each centre, costing about Rs 10 crore (Rs 100 million), will have three to four operation theatres, consulting rooms, imaging, pathology laboratory and pharmacies, with all the necessary equipment and staff. Nova has already opened a centre at Koramangala in Bangalore.

"The cost of treatment and surgeries at our centres will be 20 per cent cheaper than that of the corporate and established hospitals," says Girish Rao.

"About 60-70 per cent of surgeries in the US are now held at day-care surgical centres, as health care costs are very high in that country. The concept of day-care surgical centres was started in the US three decades ago and now it is very popular," said Chittranjan Ranawat, chairman of the department of orthopedics at Lenox Hill Hospitals in the US.

In a similar concept, pharmaceutical company Unimark Remedies' marketing arm, Zen Life Sciences, is planning to initiate a chain of Comprehensive Cancer Care centres, with investments from consulting doctors and small hospitals.

Zen plans to offer treatment for radiation, chemotherapy and pharmacies specialising in oncology, all under one roof, by teaming with cancer specialists and small hospitals. Each unit will entail an investment of Rs 5-6 crore (Rs 50-60 million).

"We plan to open 14-16 such facilities across the country within a year," said D P Srivastava, chief executive officer.

While cancer specialists are in plenty for consultation, there are only 40-50 centres in the country that offer comprehensive cancer care, which includes radiation, chemotherapy and surgical solutions. A patient diagnosed with cancer has to go to any of these centres for treatment, he noted.

If prohibitive costs were the reason for doctors desisting from buying costly medical equipment at their clinics, now manufacturers are ready to help them with a 'rented model'. In this, the equipment vendor will install the facility and the doctor will pay back the price on a day-to-day basis, depending on the number of tests done using the machine, sources said.

"This concept is catching up in India, as it helps players like us to sell more units even in rural areas and the cost of the machine can be recovered within a few years. It is like offering a business-linked loan," said Bhuwnesh Agarwal, chairman and managing director of Roche Diagnostics India, the largest diagnostics player in India.

Link: Original Article

Sixteen doctors get Padma Awards

Sixteen doctors from across the country have been awarded the prestigious Padma Awards on the eve of Republic Day, excluding a Padma Vibhushan for Dr Prathap Reddy, chairman of the Apollo Group that runs Indraprastha Apollo Hospital, for exceptional service in trade and industry.

Prime Minister Manmohan Singh’s heart surgeon Dr Ramakant Panda from Mumbai’s Asian Heart Institute was awarded the Padma Bhushan for his successful ‘re-do’ bypass surgery on the PM exactly a year ago at the All India Institute of Medical Sciences.

New York-based orthopaedic surgeon Dr Chitranjan Singh Ranawat was awarded the Padma Bhushan following the successful knee surgery of the then prime minister Atal Bihari Vajpayee.

Dr S.P. Agarwal, secretary general of the Indian Red Cross Society, and ophthalmologic surgeon Dr Noshir Shroff of Shroff Eye Clinic were the two Delhi doctors to win the Padma Bhushan, three of which also went to doctors from Kerala and Karnataka.

“The call from the home ministry on Monday morning made all our (Indian Red Cross Society’s) humanitarian work worthwhile,” said Dr Agarwal, a neurosurgeon who as India’s longest serving director general of health services,

managed health outbreaks such as pneumonic plague and Severe Respiratory Stress Syndrome.

“The award is for reaching out for those who need help the most.”

The Padma Shri went to four doctors in Delhi — liver transplant surgeon Dr A.S. Soin and nephrologist Dr Anil K. Bhalla from Sir Gangaram Hospital, Moolchand Medicity’s cardiologist Dr K.K. Aggarwal, and sports medicine expert Dr Laxmi Chand Gupta for the Padma Shri.

Dr Soin has conducted over 400 successful liver transplants, the highest in India, while Dr Bhalla is among the pioneers of peritoneal dialysis, a home-based treatment for people with kidney failure. Cadiologist Dr Aggarwal is the dean of the board of medical education at Moolchand Medcity.

Other names from the field of medicine from across the country include Karnataka’s Dr Belle Monappa Hegde (former V-C, Manipal Academy of Higher Education, Karnataka), ayurveda practitioner E.T. Narayanan Mooss (Kerala), Dr B. Ramana Rao (Karnataka), Prof Kodaganur S. Gopinath (Karnataka), Dr Philip Augustine (Kerala), Dr Rabindra Narain Singh (Bihar) and Dr Vikas Mahatme (Maharashtra).

Link: Original Article

Rural medicine course: classes to be held in district schools

According to the draft of the proposed rural medical course — Bachelor of Rural Medicine and Surgery’ (BRMS), the classes will be held in medical schools (located in district hospitals) and the examinations will be conducted as well as the degrees conferred by the university to which the medical schools would be affiliated.

Districts where no medical college exists will be given preference for establishment of these schools with a minimum of either 25 or 50 students.

The medical schools will have residential campuses, and a district-based admission system has been charted out for the course.

Those with the BRMS degree can be sent anywhere across the state, but they cannot seek service in any other state or else their degree will be rendered invalid. The draft reads: “Registration of the BRMS graduate will be worked out by the states concerned and their respective medical councils. The medical schools will be recognised for the conferment of degree by the concerned state medical council or by such authority as would be notified for the said purpose.”

The registered graduates will be under the ambit of disciplinary jurisdiction of the code of medical ethics prescribed by the Medical Council of India (MCI). Also, the registration has to be renewed on a yearly basis for four years when they get permanent registration.

The course will be broken up into Anatomy, Physiology and Biochemistry, Pathology and Microbiology, Pharmacology, Forensic medicine, Medicine and allied disciplines, Paediatrics, Surgical an allied disciplines, Orthopaedics, Obstetrics and Gynaecology and community medicine.

The draft specifies in the teachers’ eligibility criteria that medical officers without PG degree cannot go beyond Assistant Professors.

An MBBS degree holder with three years experience as medical officer is eligible for the post of lecturer; a medical officer with postgraduation qualifies as assistant professor; a medical officer with PG qualification and eight years experience as medical officer can become an associate professor; and a medical officer with PG qualification and 14 years experience as medical officer can become a professor.

While these are some of the key points mentioned in the draft, MCI president Dr Ketan Desai said: “The key points listed in the draft will be the skeleton for the implementation of this course. Only a few changes are expected in the final framework.”

Link: Original Article

South Asia's firts Medical technology park to make quality healthcare affordable in India

South Asia’s first medical technology park based in Chennai to put India on the global map of medical devices manufacture; to bring down the costs of medical technology products by as much as 30 – 50% over the next few years.

25 – acre Park at Irungattukottai, near Chennai for Indigenous manufacture of world-class medical devices.

Technology products at the park to offer international quality yet cost effective solutions to healthcare providers.

It is an idea whose time has certainly come. With healthcare costs becoming prohibitive by the day, it is imperative that initiatives like this one be promoted aggressively. The launch of the TrivitronMedical Technology Park is the first of the many steps that need to be taken to make quality healthcare affordable in the country.
The setting up of the park at Chennai is in line with the government of Tamil Nadu’s initiative of promoting Chennai as a manufacturing hub. Chennai has also been chosen in view of its reputation as a medical tourism hotspot. Its healthcare infrastructure, which includes among other things the clinical expertise on offer, has often come in for praise. What’s more, it has the added advantage of having an eastern seaport and a well-established airport.

Spread over 25 acres and designed to house 10 international medical technology manufacturers, the park aims to bring cutting edge medical technology to medical professionals across the country at affordable costs. A range of products including Ultrasound systems, Color Doppler, X – ray, C-arm, in-vitro diagnostic reagents and instruments, cardiology diagnostic instruments, critical care instruments, modular operating theatres, operating theatre lights and tables and implantable medical devices will be manufactured at the park. It is expected that the manufacture of world-class medical devices within the country will bring down the overall healthcare costs dramatically.

Inaugurated by Dr. Prathap. C. Reddy, Chairman, Apollo group of Hospitals, the Aloka Trivitron Medical Technologies facility will engage in the manufacture of ultrasound machines, high end colour dopplers and advanced imaging systems. Aloka Trivitron Medical Technologies is a joint venture between Aloka, a Japan based company credited with pioneering the diagnostic ultrasound technology globally and Trivitron.

“For quite some time now there has been a felt need of making quality healthcare not only available but also affordable. With the setting up of this park this need will certainly be met. Indigenous manufacture of world class medical devices in collaboration with the bestmedical technology companies and research institutes in the world will spawn a new era in the spread of life saving medical technology across the country”, said Dr. Reddy.

In his welcome address Dr. Parthasarthy, Director, Trivitron Group of Companies emphasized that the products manufactured at the facility will adhere to international standards such as ISO 9000 – 2001, ISO 13485, CE, US FDA and Japan MITI certifications.

With this it has some world class facilities like, fully ESD tiled production area of 12,000 sq.ft.(ESD helps in discharging of electrical charges within human being thus calibiration of the instruments are not affected), with this whole are is connected with CCTV for a complete view on all the activities. It has been kept in mind the importance of nature and science and whole area is Green/Eco friendly with ample usage of natural light with ample water harvesting capacity.

In his keynote address Dr. G.S.K.Velu, Founder and Managing Director, Trivitron Group of Companies expressed hope that the setting up of the park will catalyze the rapid spread ofmedical technology across the country. “The setting up of this park is a dream come true. With this we plan to put India on the global map of medical technology manufacturing. The fact that this initiative will eventually help bring down healthcare costs, facilitating the spread of advancedmedical technology across the country is a source of great satisfaction for me”, he said.
Trivitron Healthcare Pvt. Ltd. is looking at setting up more facilities at the park very soon. To this end, the company has already signed joint ventures with leading international medical devices manufacturers. These include Brandon Medical, UK, ET, Cardioline, Italy, Johnson Medical, Sweeden and Biosystems, Spain.

V.K.Subburaj, Principal Secretary, Department of Health and Family Welfare, Govt. of Tamil Nadu hailed the setting up of the park as a giant stride towards self – sufficiency in medical devices manufacture. He said that this unique initiative will go a long way in ensuring that quality healthcare becomes widely available. A reduction in the manufacturing costs of medical devices, he said, will in turn reduce the overall healthcare costs significantly.

Prominent among others who spoke were Minoru Yoshizumi, President Aloka Ltd. Japan and V.R.Venkatachalam, Chancellor, Sri Ramachandra Medical University who also felicitated the chief guest.

Link: Original Article

Website For Appointments With Doctors A Hit In US

ZocDoc, a free service that allows patients to book doctor appointments online, has become a major hit in at least three cities in US.

Started in September of 2007 as a service to help people find and make dentist appointments, today ZocDoc also offers primary care, dermatologist, eye-specialist, ENT, orthopedist, OB/GYN, allergist, podiatrist, cardiologist, pediatrician, radiologist and psychiatrist appointments in three major cities including New York City.

Mr. Cyrus Massoumi thought up the idea after the hassles he had to undergo when he had his eardrum ruptured on a flight. It took him three days to get at the right doctor, and who was also covered by his insurance plan. Though New York city had more doctors per capita than any other urban center in the world, getting an appointment with the right doctor proved a tortuous process for him, CNNMoney reported.

His experience troubled him a lot, and eventually Mr. Massoumi joined hands with Oliver Kharraz MD to float ZocDoc.

“My family has a 300 year old tradition of being doctors and I believe old fashioned values can be combined with modern medicine and technology. I work at ZocDoc because I want to build a service that puts patients first,” says Dr.Kharraz.

By being modest in their ambitions, the duo have succeeded. They started by targeting doctors in just one metropolitan area.

When ZocDoc.com went live in September 2007, it only scheduled appointments with dentists in Manhattan. Now the site books visits for tens of thousands of doctors in 14 specialties across New York's five boroughs and in Washington, D.C. and San Francisco.

ZocDoc recently added its first hospital, the New York Eye and Ear Infirmary, which brought 800 new doctors onto the company's roster.

ZocDoc is free for patients and levies a flat fee for doctors, ranging from $100 to $250 per month. In November, approximately 110,000 people used the service to find a doctor.

Apart from scheduling visits, ZocDoc encourages patients to rate and review doctors they've seen, a feature many say is a welcome help.
Link: Original Article

IMA rubbishes rural medicine degree plan

The Medical Council of India's decision to introduce four-year courses in Bachelor in Rural Medicine and Surgery will only produce "qualified quacks," the Indian Medical Association has said.

In a strongly-worded statement on Saturday, IMA Tamil Nadu chapter president Dr R Gunasekaran and secretary Dr TN Ravisankar said the such ill-trained doctors could mismanage patients causing complications and even deaths.

The need of the hour is to train paramedical or multi-purpose health workers and equip them with the knowledge to identify infectious diseases, insect and animal bites and other illnesses in the earlier stages and refer them to qualified doctors.

"The existing four-and-a-half years of medical education and another year of internship itself is inadequate. It takes another five years for a fully qualified doctor to gain comprehensive knowledge. Compared to this, a BRMS will only be a qualified quack," the statement said.

Link: Original Article

Health insurance plan for the poor in Uttar Pradesh set to go online

The Uttar Pradesh Rural Development department is set to go online with its Rastriya Swasthya Beema Yojna (RSBY) scheme available across 71 districts of the state.

To be available in a month’s time, the online facility will enable the department to keep track of monetary transactions between insurance companies and enlisted hospitals.

In addition to allowing beneficiaries to check their insurance amount and per entry usage, the system will also keep an update of all the hospitals empanelled under the scheme.

The Centrally-supported scheme was launched in April 2008. It provides health insurance to around 1 crore Below Poverty Line (BPL) families in the state.

As many as 8, 37,837 smart cards have been distributed in the state till now. The smart card cost beneficiaries Rs 30 annually and covers medical expenses up to Rs 30,000 for five members of the card holder’s family. Having tied up with ICICI Lombard as the insurance agency, the Centre pays Rs 550 per month as premium for insurance in the scheme.

The scheme had all its monetary transactions and monitoring done online for the 15 districts which were covered under the scheme in the first phase till April 2009.

The records maintained by hospitals were, however, not available on the internet, making it difficult for departments to tally data provided by the insurance company.

To promote transparency in the system, the names of card holders who have claimed insurance will appear online along with their hospital records for anyone to check,” said Anurag Yadav, Additional Commissioner (Rural Development) handling the RSBY. He added: “With this, the smart card holders will be able to check the insurance amount still left with them each time the card is swiped for medical reimbursement. As more hospitals get empanelled for the scheme, the updated list of hospitals will also be uploaded for the beneficiaries.”

As many as 550 private and 30 government hospitals have been empanelled under the scheme. “Though some of the hospitals have managed the records well, there have been anomalies reported in case of other hospitals. Due to lack of awareness, some of the hospitals delayed their submission of paperwork, which made the process of recovery of money tedious for them,” said an official.

He added: “With online records, we will be in a better position to manage and tally records of hospitals and insurance companies. We will also remind hospitals about completion of paper work on time.”

Link: Original Article

Clean up act or hand over ESI hospitals, Centre to tell states

After repeated reminders to state governments to tone up ESI hospitals, the Centre is set to send out a strong message to them to either infuse efficiency in these facilities or hand them over to the Employees’ State Insurance Corporation (ESIC).

On the eve of the state labour ministers’ meet convened by it here on Friday to review the performance of various central schemes and initiatives, Union Labour Minister Mallikarjun Kharge said several ESI hospitals were in a “very bad shape” because of the shortage of doctors and lack of medicines and equipment. There are over 120 ESI hospitals across the country.

“While the Centre bears 87.5 per cent of the operational cost, the administration of these hospitals lies with the states. We are not satisfied with the situation. Our view is that either you run these hospitals properly or hand them over to the ESIC,” he said.

Sources said the occupancy rates in around 30 of the 120-odd hospitals are below 30 per cent. Only a handful has more than 80 per cent occupancy rates. The total number of beneficiaries eligible for medical care under the ESIC scheme is over five crore. “We are prepared to take over these hospitals,” Labour Secretary P C Chaturvedi said.

The agenda for the meeting circulated by the Labour Ministry points out that a large number of posts in these hospitals are lying vacant, hampering delivery of medical care services resulting in dissatisfaction among the beneficiaries, and notes that many of the states are not able to procure the equipment sanctioned by the corporation while purchase of drugs is irregular resulting in non availability of drugs.

“Due to non availability of drugs, patients are required to purchase drugs from the market and their medical reimbursement bills are delayed. This is the main cause of complaints regarding delivery of medical care to the insured persons,” the agenda said.

Sources said Himachal Pradesh, Madhya Pradesh, Bihar and Meghalaya have already given their consent to the Centre to take over administration of ESI hospitals in their states.

The Centre is also likely to ask the states to pull up their socks in implementing various schemes formulated by it, particularly upgradation of Industrial Training Institutes (ITIs). It is noticed that delay in release of funds and under utilisation of funds are slowing down the programme aimed at modernising 500 ITIs.

Sources said utilisation of funds for upgrading 1,396 Government ITIs in the Public Private Partnership mode, a scheme launched three years ago, is also not satisfactory. While just two months are left for this fiscal to end, many of the state governments have not yet sent proposals of ITIs to be covered in 2009-10. “Out of 300 ITIs to be covered only 155 proposals have been received so far,” said an official.

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Hospital chain Fortis aims to be $1-bn entity in 3-4 yrs

Hospital chain Fortis Healthcare today said it aims to become a billion dollar company in the next three to four years on the back on ongoing expansions.

"Our targets should now shift from number of hospitals in cities and states to revenue based-targets and we hope that over the next couple of years, we get to billion dollar revenue as a company," Fortis Healthcare Managing Director Shivinder Mohan Singh said in a conference call while announcing the results.

The company, which is currently undergoing expansion across the country besides adding bed capacities through the acquisitions of Wockhardt Hospitals and Malar Hospitals, has a network of 45 hospitals with a capacity of 6,600 beds.

Singh, however, did not specify by how much the hospital chain's bed capacity will rise in the next three-four years.

In the nine month-period of the ongoing fiscal, Fortis Healthcare has reported a revenue of Rs 608.4 crore with a profit of Rs 43.3 crore.

Last fiscal, the firm's total revenues stood at Rs 630 crore.

Earlier in 2007, Fortis had set a target of having 6,000 beds and 40 hospitals by 2012. However, with the help of the acquisition of 10 hospitals from Wockhardt, it has achieved the target.

"As a company, Fortis has always met the target ahead of schedules and this time also we would try to do it in the next three-four years," Singh said.

Last year, making a largest ever deal in the India's healthcare segment, Fortis acquired 10 hospitals, including two under-construction units from the debt-ridden Wockhardt Group for Rs 909 crore. In 2008, it had acquired the Chennai-based Malar hospitals for Rs 34.6 crore.

Speaking about the company's plans for Wockhardt hospitals, Singh said, in the next three-four months, these would be branded as Fortis group hospitals.

"We would form a subsidiary as Fortis Hospitals, which would be headed by Malvinder Mohan Singh and all the 10 hospitals would be placed under this subsidiary," he said.

Link: Original Article

February 01, 2010

Accreditation latest hit with hospitals

To attract patients, hospitals are increasingly using accreditation as a bait.

They are using the certification from the National Accreditation Board for Hospitals and Healthcare (NABH) to highlight their quality, efficiency and effectiveness.

Bhawna Gulati, assistant director, NABH, said about 366 hospitals in India are in the race to get accredited. “40 have already been accredited. During accreditation, which is a mark of excellence, performance is assessed in relation to the set standards needed to drive quality.”

Girdhar J Gyani, secretary general, Quality Council of India, of which NABH is a constituent board, said, in case accredited hospitals deviate from set standards, they would be looked into and, if need be, the accreditation suspended till the deviations are corrected. “There would be monitoring of accredited hospitals to ensure that the standards are followed.”

“There is a change in perception among government hospitals and they are becoming more conscious about quality standards like private and corporate hospitals,” said Gyani.

Industry experts say accreditation is the need of the hour to boost the hospital’s image and thus, indirectly, revenues.

As accreditation helps in ironing out inefficiencies and improving processes, which could boost margins of hospitals by between 5% and 6%.

However, to get accredited, hospitals have to spend crores of rupees to set the systems in place. For example, a 100-bed, decade-old hospital could spend Rs 3-4 crore for structural improvements.

Anil K Maini, president, corporate development, Apollo Hospitals, said accreditation, especially from international authorities like Joint Commission International (JCI), is crucial for pulling in patients from across the world.

Accreditation ensures that guidelines are in place to protect against nosocomial or hospital-acquired infections, fire, chemicals, etc, said S C Sood, chairman, quality department, BL Kapoor Memorial Hospital in New Delhi. “We are working on getting accredited by NABH and all the requirements have been implemented.”

Insurance companies also look favourably upon NABH-approved hospitals, said Vivek Desai, managing director of healthcare consultancy firm Hosmac.

“Central government health scheme will make it mandatory for accreditation.”

However, some experts feel, though accreditation will ensure quality, it may not necessarily translate into higher patient inflows.

Ankur Bharti, consultant, Technopak, says due to poor awareness about accreditation, patients might not be able to properly differentiate between accredited and non accredited hospitals.

“It would be difficult to say how much a hospital may be able to harness out of accreditation.”

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Railways to set up diagnostic centres near stations

In what could give a big boost to health infrastructure in India, the Railways today joined hands with the Health Ministry to set up diagnostic centres, hospitals and nursing colleges in vacant railway land across the country.

Railways, which possess vast tracts of vacant land all over the country, had been toying with the idea of setting up healthcare facilities with Railway Minister Mamata Banerjee announcing intentions in this regard in her budget speech.

The plan could see setting up of diagnostic centres initially as both the ministries plan to address the increasing primary and tertiary healthcare needs.

Establishment of multi-speciality hospitals and nursing colleges are also on the cards.

The two ministries have decided to set up a committee to finalise the broad framework for implementation of the ambitious project.

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Medical records not under RTI: court

The Delhi High Court Tuesday ruled that income tax returns and medical records do not fall under the purview of Right To Information (RTI) Act "unless public interest is attached" holding in its landmark judgment that the Chief Justice of India (CJI) came under the ambit of the transparency law.

Quoting an American writer that "one man's freedom of information is another man's invasion of privacy", a full bench of Chief Justice Ajit Prakash Shah and Justices S. Muralidhar and Vikramjit Sen said: "Personal information including tax returns, medical records etc. cannot be disclosed in view of Section 8(1)(j) of the act."

"If, however, the applicant can show sufficient public interest in disclosure, the bar (preventing disclosure) is lifted and after duly notifying the third party (the individual concerned with the information or whose records are sought) and after considering his views, the authority can disclose it," they said.

Highlighting how the right to information often clashes with the right to privacy, the court noted that the government stores a lot of information about individuals, supplied by the individuals themselves in applications made for obtaining various licences, permissions including passports, or through disclosures such as income tax returns or for census data.

"When an applicant seeks access to government records containing personal information concerning identifiable individuals, it is obvious that these two rights are capable of generating conflict," the court said, adding that "in some cases, this will involve disclosure of information pertaining to public officials. In others, it will involve disclosure of information concerning ordinary citizens. In each instance, the subject of the information can plausibly raise a privacy protection concern."

However, the court ruled that notes made by the judges do not come under the RTI act, the court said the notes taken by judges while hearing a case cannot be treated as final views expressed by them on the case. "They are meant only for the use of the judges and cannot be held to be a part of a record 'held' by the public authority. However, if the judge turns in notes along with the rest of his files to be maintained as a part of the record, the same may be disclosed."

Maintaining that the right to information may not always have a linkage with the freedom of speech, the court said: "If a citizen gets information, certainly his capacity to speak will be enhanced."

"But many a time, he needs information which may have nothing to do with his desire to speak. He may wish to know how an administrative authority has used its discretionary powers. He may need information as to whom the petrol pumps have been allotted. The right to information is required to make the exercise of discretionary powers by the executive transparent and, therefore, accountable because such transparency will act as a deterrent against unequal treatment," the court said.

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