November 28, 2010

New antibiotic policy may be introduced in 3 Delhi hospitals

To start with, the new national antibiotic policy is likely to be introduced in three central government hospitals in Delhi — Lady Hardinge Medical College, Safdarjung Hospital and Ram Manohar Lohia Hospital.

The policy, drafted by experts from the National Institute of Communicable Diseases, AIIMS, Indraprastha Apollo and others under the chairmanship of Drug Controller General of India (DCGI) Dr RK Srivastava, was on Tuesday sent for approval to Union Health Secretary K Sujatha Rao.

The experts recommended that the guidelines be implemented in the three hospitals as a pilot project and then in other hospitals across the country. Once cleared by the secretary and Union Health Minister Ghulam Nabi Azad, the policy will be sent to Parliament for the creation of a separate Schedule-HX under the Drugs and Cosmetics Act and making it mandatory for antibiotic drugs to be sold against prescriptions.

As per the new rules, doctors will have to write prescriptions for antibiotics in duplicate. The chemist will have to retain one copy for a year from the date of sale in order to facilitate verification and audit.

The decision to formulate a new policy was taken by the DCGI last month to prevent misuse and overuse of antibiotics. The evolution of the ‘superbug’ NDM-1, resistant to even the most powerful group of antibiotics, has been blamed on antibiotic overuse.

About 16 high-end antibiotics, including Meropenem, Cefepime and Moxifloxacin have been put under the new schedule. Also, 58-odd antibiotics such as Penicillin, Ampicillin and 15 drugs containing codeine as well as first-line TB drugs such as Rifampicin, Isomiazid, Pyrazinamid and Ethambutol will require duplicate prescriptions.

Violators will be punished with a fine of at least Rs 20,000 and a year’s imprisonment, which may be extended to two years. The experts have also proposed that hospitals compulsorily set up a “drug control committee” to approve high-end antibiotics and an “infection control committee” to track and analyse infections.

Link: Original Article

November 27, 2010

Firm says top hospitals violate biomedical waste disposal norms

As many as 174 private, civic and government hospitals and nursing homes in the city have been found violating norms regarding handling and disposal of biomedical waste by a BMC-appointed firm for the purpose. These include top BMC hospitals such as BYL Nair, Sion Hospital, Kasturba Hospital, state government hospitals such as JJ Hospital and Cama Hospital and high-end private hospitals such as Lilavati, Kokilaben Ambani, Fortis.

The Maharashtra Pollution Control Board, acting on a complaint sent to it earlier this month by the agency handling biomedical waste in the city, has started physical inspection of these hospitals. Those at fault will be served show cause notices and will be liable to strict penalty under the Bio-medical Waste (Management and Handling) Rules, 1998.

Improper segregation of bio-medical waste (BMW) before disposing it into an incinerator can cause emission of highly toxic byproducts, including dioxins, a carcinogen. The list was sent by Sms Envoclean — the firm appointed by the BMC — to the MPCB.

The firm gathers about 12 tonnes of biomedical waste produced from over 1,200 city hospitals daily and treats them at the biomedical incinerator situated within the premises of the Deonar dumping ground. An official from the firm said many hospitals do not carry out the required segregation which hampers the operations in the incinerator that emit dangerous gases. “Plastic IV fluid bottles, body parts, syringes and soiled bandages are all dumped in the same bag instead of being segregated. Almost 90% of the waste comes unsegregated and it becomes impossible for us to segregate it at the plant,” he said.

MPCB regional officer DB Vadde said that as per the law, biomedical waste has to be segregated in ten categories such as human body parts, expired medicines, medical equipment, plastic IV bottles etc. “If such segregation is not done and for instance if plastic is incinerated along with other bio-medical waste, you are sure to produce dioxins. We have received a written complaint from Sms Envoclean and we will verify their claims by inspecting these hospitals ourselves. Four MPCB teams have been formed for this purpose and those hospitals violating norms can face a fine up to Rs 1 lakh and in extreme cases, cancellation of license,” said Vadde.

MPCB had, in August, sent notices to 47 hospitals in the city for similar violations and given them a period of 15 days to rectify their waste disposal system. Vadde said that most hospitals that were served notices started following norms later.

Residents associations in areas close to the Deonar dumping ground have repeatedly protested against the haphazard treatment of BMW at the incinerator without proper air-quality check systems.

Link: Original Article

November 26, 2010

Mobile health services need a sustainable business model in India

Even as India attempts to scale up access to e-health, the industry is already talking about the next step in health technology—mobile health, or m-health.

M-health will attempt to go one step further and bring health services right to the mobile phone, with junior doctors functioning in a centre much on the lines of a call centre.

At the India Economic Summit of the World Economic Forum, a varied range of panellists brainstormed on the opportunity that lies in m-health at a session on Shaping India’s Mobile Health Ecosystem.

The global m-health technology market is expected to grow 25% annually, from the current $1.5 billion (Rs10,125 crore) to $4.6 billion by 2014.

“The mobile has transformed the way we work, and broadband and connectivity will provide never before (levels of) communication. This is the start to the best possible technology to bring greater access to healthcare,” said Malvinder Mohan Singh, chairman, RHC Holding India Pvt. Ltd.

While m-health creates a whole world of opportunities in healthcare delivery, the key question is whether it can be a sustainable business model.

Sachin Pilot, minister of state for communications and information technology, said that while the idea of m-health is exciting, the biggest challenge would come in the form of language diversity.

“We must not lose time. This is not one ministry’s job… the IT (information technology) ministry and health ministry have to come together to work on this. At the same time, we must keep in mind that India is a very price-sensitive market, so unless the access to m-health is affordable, it won’t work,” said Pilot.

Sangita Reddy, executive director, operations, Apollo Hospitals Enterprise Ltd, said the country cannot afford to create silos of capability.

“How do we find a way to create accessibility? We cannot think of just m-health. Before m-health we have to excel in e-health and before that we have to create basic healthcare for all. It has to work in one continuum,” said Reddy.

She added that projects would need to be started on a pilot basis as part of corporate social responsibility, and then, depending on their success, could be scaled up into sustainable business models.

While all the panellists agreed that m-health could be the future of basic healthcare, it would largely depend on building a sustainable business model for e-health with various service and healthcare providers coming together to work on this.

“This can be a sustainable model, but don’t expect an ebitda (earnings before interest, taxes, depreciation and amortization margin) of 80%,” Pilot said.

Link: Original Article

November 25, 2010

Common exit exam for medical graduates soon

Health Minister Ghulam Nabi Azad Tuesday said the central government is contemplating holding a common exit exam for medical graduates based upon the recommendations of the Medical Council of India.

In a written reply in the Rajya Sabha, Azad said the 'common exit exam' has been suggested by the task force constituted for creation of an overarching body for medical education -- the National Commission for Human Resources for Health.

'The central government had constituted a task force to recommend for creation of an overarching regulatory body in inter-related fields of medicine viz. National Commission for Human Resources for Health (NCHRH),' Azad said in a written reply to the Rajya Sabha.

'The task force, after consultations with the stakeholders, including the Medical Council of India, in its report has suggested an exit test for medical graduates to improve the standards of medical education in the country,' he said.

According to ministry sources, the exam will be similar to the exit exams conducted by the Bar Council of India for law graduates.

Link: Original Article

November 24, 2010

Financial support to medical tourism service providers

Medical tourism is now included under the Marketing Development Assistance (MDA) scheme, under which medical tourism service providers will be given financial assistance, the tourism ministry said Monday.

Medical tourism service providers include representatives of hospitals accredited by the Joint Commission for International Accredited Hospitals (JCI) and National Accreditation Board of Hospitals (NABH), travel agents and tour operators approved by the tourism ministry.

The tourism ministry has sanctioned Rs.12.47 lakh as MDA to 10 medical tourism service providers for the current year, a tourism ministry statement said.

Link: Original Article

November 23, 2010

Malaysia to work with Indian govt to hire medical specialists

Malaysia's Health Ministry has said it will work directly with the Indian government to hire qualified medical specialists to help tackle the shortage of doctors in Malaysia.

Health Minister Liow Tiong Lai said his ministry had advertised in the foreign media for specialists but the applicants were not very good, local media reported.

Apart from India, Malaysia will also work with the governments of Egypt and Pakistan to hire qualified medical specialists, he said.

Malaysia wants to project itself as a medical tourism hub but lack of medical specialists in some areas is coming up as an obstacle in this path.

"The doctors who replied to our advertisements were qualified but many of them were sent back because of attitude problems," the minister said.

"Of course, these doctors also had to go through an interview locally. But, sometimes, they could not perform according to our expectations," he said.

By working directly with the governments, "we would be able to hire better doctors, as they would be vetted by both the foreign and local governments," he said.

Liow said the Egyptian Health Ministry submitted a list of 58 specialists who would be recruited to work in local hospitals or medical facilities.

"The Egyptian government has given these specialists sabbatical leave. So, many of them are more than willing to leave their country and serve here," he said, adding that the agreement was for these doctors to serve only for two years.

Liow said the same system would be applied to recruit specialists from India and Pakistan.

Link: Original Article

November 22, 2010

MCI plans central platform to give boost to research

In a bid to encourage research in medical science in the country, the Medical Council of India (MCI) is considering setting up of a central platform for researchers. The new set up will give awards for superior research work in the area of medical science as well as come up with research facilities at the institute level.

The MCI is also considering to start an MD-Ph D programme under which a student enrolled in MD programme can simultaneously pursue Ph D so as to boost research work in the field of medical science.

Dr SK Sarin, chairperson of the Board of Governors, MCI, announced this during the Research Showcase held at Chhatrapati Shahuji Maharaj Medical University here on Saturday.

“We do not recognise our researchers, the young talent of the country. By 2011, the MCI is trying to have a research platform at the central level for the recognition of good researchers of the country,” said Dr Sarin.

Talking to The Indian Express, Dr Sarin said: “We will very soon initiate a dialogue with the Indian Council of Medical Research for this platform where we can have separate research cell as well as awards for significant medical research. I will be meeting Dr VM Katoch (Director General, ICMR )in this regards very soon as it is in ICMR’s mandate to establish such a platform,” said Dr Sarin.

Link: Original Article

November 21, 2010

Little doctors with big jobs

Geeta Varma has made it a point to boil the drinking water she fetches from a hand pump near her hut in Babrekar Nagar at Malad’s Malvani area. She also covers the food she cooks to protect it from the filth in the narrow lanes of her slum. “My son, Mithilesh is training to become a bal doctor,” said Varma. “He has taught me about good hygiene and the importance of keeping your surroundings clean.”
Fifteen-year-old Mithilesh enrolled for the bal doctor programme six months ago.

An initiative by Youth for Unity and Voluntary Action (Yuva), the programme aims to train children to administer first aid and to handle medical crisis.

They have also been taught how to identify symptoms of different diseases and to encourage people to seek treatment.

Since 2000, the organisation has trained 676 bal doctors from 34 slums across the city.

A fortnight ago, Suraj Kanojia, 15, another bal doctor, realised his mother was suffering from chikungunya and persuaded her to go the hospital.

“She was unwell for a few days, but was unwilling to go to the hospital. From her symptoms I could make out that this was not an ordinary flu,” said Kanojia.

“I have become more aware of my own health and now I also take my parents to the hospital when they are unwell,” said Ravi Gupta, 18, who was part of the first batch of bal doctor trained in the area.

“Many of our young volunteers have understood the importance of hygiene and cleanliness,” said Sumati Belady, a social worker who trains the youngsters.

In order to spread the message, these children are also performing street shows about different diseases in their own locality.

The concept of bal doctors took root when a street boy from Mumbai Central suggested to the NGO workers that they be given a medical kit with basic medicines and first aid so they could treat their friends without delay.

According to programme coordinator Arokia Mary, Yuva had started a health van to give medical services to children in areas where medical facilities were almost non-existent.

“However, due to lack of time and resources, the van could not reach everyone. This is where the bal doctors fill in for us,” said Mary.

“There are so many children in our locality who chew tobacco and smoke cigarettes. Due to this training, my friends and I have never indulged in these things,” said bal doctor Kurban Khan, 18, who now wants to go to college and purse higher education.

“Several of our older children want to pursue higher studies in the medical field. This programme has contributed significantly in boosting their confidence,” said Mary, adding that Yuva now wants to take this concept to schools.

Link: Original Article

BPOs seek doctors, lawyers, CAs, engineers, PhDs, MBAs

For nine years now, Dr Neel Deep Singh Sarvaiya, a family physician in Andheri, has been training young professionals in medical terminology.

However, the people he trains are not medical students, but those looking for careers in business process outsourcing (BPO).

Dr Sarvaiya works with CBay Systems, an Airoli-based BPO engaged in medical transcription, in the mornings and treats patients in the evenings. He says BPOs have opened up a completely different avenue for doctors and other professionals. “So many people with diverse backgrounds want to make careers in a BPO.”

Once associated mainly with college students looking to make a quick buck during vacations, BPOs today employ people with degrees such as MBBS, BSc Nursing, PhD, MBA, CA, BE and BPharm.

“The perception that the BPO sector is not knowledge-driven and is merely a stop-gap career option no longer exists,” says Sanjiv Kapur, senior vice-president and global head, Patni BPO.

According to Manuel D’Souza, chief HR officer, Intelenet Global Services, the need for highly specialised people is because BPO service offerings have widened to include transaction processing, consulting, customer care, technical support, research and analytics, compared with mostly voice related activity earlier.

BPOs service sectors like travel, insurance, banking, financial services, retail, logistics and healthcare, which require highly skilled people, says Keshav R Murugesh, group CEO, WNS Global Services, which has 18,000 people in India, including a large number of doctors, MBAs, CAs and lawyers.

Raghavendra K, vice-president and head, HR, Infosys BPO, which has about 19,300 people, says most entry level profiles are sourced from science, computers, philosophy and theology backgrounds.

“Research, consulting and other such activities now constitute nearly 40-50% of the total BPO sector. So we need CAs for finance, MBAs/engineers for consulting and so on,” says D’Souza.

Kapur says doctors and nurses are needed as BPOs work on behalf of insurance firms to manage medical care of elderly citizens.

“An offshore team of doctors and nurses is involved in reviewing medical records, ensuring if medical check-ups are done in time, timely administration of medicines,” says Kapur, explaining that patients’ medical assessment sheets are sent to the BPO in India, where medical professionals analyse patient details and the information is then sent to the insurance company, and based on this assessment, future diagnosis is done.

Raman Roy, chairman, Quatrro BPO, points out that the sector had even felt the need for PhDs when the human genome project started.

For actuarial work (calculating insurance risks and premiums needed to cover the risks and designing insurance policies) in the area of pensions, property and casualty, etc, science and math graduates as well as actuarial students are needed.

Moreover, BPOs are engaged in activities like medical writing and clinical data management for pharmaceutical companies, which requires doctors and pharmacists, say industry experts.

“All these skilled professionals get international exposure, stable career and good salaries, which is chief attraction,” says Roy.

Also, for doctors who would ideally need a gestation period of 3-4 years to establish practice, BPOs provide them with an opportunity to utilise their knowledge and earn decent money, says Dr Sarvaiya.

In terms of salaries, starting salaries of specialised graduates would be 3-4 times higher than those of plain commerce/arts graduates.

“These factors conjure up to provide professionals with good career growth. We have so many employees who have completed more than 10 years,” says Sanjay Shanmugaum, vice president, HR, CBay Systems.

With demand for specialists growing, the $12.4 billion BPO sector, which currently employs more than 750,000 people, plans to more than double the proportion of such professionals in the next two years.

Roy says the high-end business in BPOs, requiring specialists, is growing at 30% per year. “Currently, we have 600 specialists who make up 20% of our total employee count and that percentage will keep increasing due to the demand.”

D’Souza says from about 10-15% (of total employee base of 33,000) at present, the percentage of specialised professionals will reach 30% in the next 2-3 years.

The staff strength of 6,200 would increase to 10,000 by the end of 2010, Shanmugaum says, adding, “80-90% of our staff have MBA, MBBS and other professional qualifications.”

Link: Original Article

November 20, 2010

86% of all medical trips are made by rural Indians

The story of India's international medical tourism industry is now well known, but the first ever figures on domestic medical tourism are simply staggering. Indians made 126 million domestic trips for medical purposes, spending over Rs 23,000 crore on such trips, over the span of one year (2008-9) alone. That, incidentally, is about 30% more than the Union health budget for the same year.

But just as international migration into India largely reflects a choice of greener pastures while domestic migration is more as a result of the lack of economic opportunity in rural areas, domestic medical tourism too is largely the outcome of poor health infrastructure in rural areas and small towns. 86% of all trips taken for medical purposes are by rural Indians and the poorest spend much more proportionally.

The data is part of the National Sample Survey Organisation's (NSSO) 65th round on tourism which estimates the number and purpose of "trips" taken by persons in its representative sample of seven lakh persons as well as the expenditure on them. The survey defines a "trip" as the movement - for a period of not more than six months - by one or more household members traveling to a place outside their usual environment and return to their usual place of residence for purposes other than migration or employment and which is outside their regular routine of life.

The survey data shows that trips for 'health and medical purposes' form 7% of overnight trips for the rural population and about 3.5% for the urban population. While "social" purposes were the main reason for travel for both rural and urban residents, holidaying and leisure accounted for even less than medical travel - 2% and 5% for rural and urban India respectively. Similarly, 17% of same-day trips for in rural India and 8% in urban India were for health reasons.

While calculating the expenditure on a trip, the NSSO includes all goods and services bought or consumed by the traveler. The high cost of healthcare is borne out by the fact that trips for health and medical purposes were four times as expensive as the average trip for both rural and urban populations. Medical trips were much more expensive for the family than even shopping trips, where the money spent on purchasing goods is included in the total cost of the trip. Trips for health and medical purposes were the most expensive of all types of trips in both urban and rural sectors.

Expenditure on medical trips accounted for 30% of all overnight trip expenditure for rural India and 15% for urban. In addition, a breakdown of expenditure by Monthly Per Capita Expenditure (MPCE) classes shows that in rural India, the poorer the person, the higher the proportion of all travel expenditure that goes to medical trips.

A visit to Delhi's public hospitals only bears out these statistics. On Tuesday and Wednesday mornings, hundreds of people from all over the country thronged the two hospitals' OPDs, with ailments ranging from tuberculosis to cancerous tumours. Subhash Majhi (52) and his wife came here from Orissa's Sambalpur district last week, seeking treatment for a tumour on his back. "I did not get good treatment in Bhubaneshwar and the problem recurred. Our relatives told us that we would have to go to AIIMS," said Majhi, who is living in west Delhi with acquaintances. AIIMS alone receives 10,000 patients every day, the bulk of them from outside Delhi, AIIMS officials said.

Others have come here with no place to stay. Kanti Devi and her husband Gyanchand Kumar, both in their 30s, have left their children in the custody of their relatives in western UP's Muzaffarnagar district. "It is harvest season at home and we are losing work, but I was not getting better, so we had to come to Delhi," says Kumar, an agricultural labourer, who has come here with respiratory problems. The couple, who were in Safdarjung's OPD having just arrived in the city, planned to sleep on the streets.

Unlike in international medical tourism, where transport and accommodation expenditures also form a significant proportion of the trip's cost, three-fourth of the expenditure on a domestic medical trip is on medical expenses alone.

There were roughly 300,000 international visits into India for health treatments in 2009 and the size of the industry is estimated at Rs 8,500 crore, less than a third of domestic 'medical tourism' spending.

Link: Original Article

Keep off Siddha docs practising allopathy , HC tells police

The Madurai bench of the Madras high court has quashed criminal cases filed against seven Siddha doctors for practising allopathy and observed that the police should not interfere in such matters, as it would demoralise the qualified practitioners of the Indian Systems of Medicine.

Allowing petitions filed by S Arockia Varghese, M Ravindran, A Nagarajan, G Suresh Khanna and Porkodi of Tirunelveli district and A Ganeshamoorthy and S Valli of Dindigul district, Justice G Rajasuria said the police cannot interfere in such matters, as it affects the morale of qualified Siddha doctors. If any person was affected by the practice of allopathy by these Siddha doctors, they would have to petition the Tamil Nadu Siddha Medical Council or the Director of Public Health.

He also said the government order of September 8 stated that institutionally qualified practitioners of the Indian Systems of Medicine such as Siddha, Ayurveda, Homoeopathy and Unani were eligible to practise modern scientific medicine based on their training and teaching. Following this, the DGP issued a circular to the police commissioners, inspector-generals of police and superintendents of police directing them not to interfere with the practice of registered doctors of Indian medicine.

The judge said the police should not interfere in such cases, even if complaints in this regard are received from the public against Siddha practitioners with a BSMS degree (Bachelor of Siddha Medicine and Surgery).

The high cout order is in line with the recent trend of protecting qualified practitioners of Indian medicine systems from legal action for prescribing allopathic drugs. In September, the state government issued a notification amending a rule under the Drugs and Cosmetics Act defining a 'registered medical practitioner'. By this, the government will treat practitioners of alternative Indian systems, including siddha, as persons practising the modern scientific system of medicine' for the purposes of enforcing the drugs and cosmetics law. It was aimed at ensuring that siddha, ayurveda and unani practitioners face no proceedings under the Drugs and Cosmetics Act for prescribing or storing allopathic medicines.

The Indian Medical Association's Tamil Nadu chapter has said it will to challenge the new rule.

Last July, the Madras high court ruled that registered practitioners of Indian systems were eligible to practise surgery. "It is imperative that no proceedings can be initiated against any of those registered practitioners in siddha, ayurveda, homoeopathy and unani, who are eligible to practise their respective system, along with modern scientific medicine, including surgery," the court had said.

Link: Original Article

November 19, 2010

Supreme Court frowns at health ministry for opposing combined AIPMT, AIEEE from 2011

The Supreme Court on Friday frowned at the health ministry's opposition to the Central Board of Secondary Education (CBSE) proposal to hold a single examination for class XII passouts for medical and engineering colleges at the all-India level by integrating AIPMT and AIEEE.

When counsel for health ministry Aman Ahluwalia cited logistical problems in conducting a single test and subsequent counselling for students, a Bench comprising Justices R V Raveendran and A K Patnaik wondered as to how it could go back on its word.

CBSE's counsel, senior advocate Altaf Ahmed, drew the Bench's attention to the minutes of a joint meeting of representatives of both health and HRD ministries as well as CBSE, Medical Council of India ( MCI) and Directorate General of Health Services (DGHS) where everyone agreed to the proposal to integrate AIPMT and AIEEE.

The Bench said: "Your objection appears to be technical as you (the health ministry) had clearly mentioned in your affidavit that you shared the concern and commitment of CBSE to ensuring that the examination system is designed in a manner where it maximizes the choices afforded to candidates and minimizes the stress, expenses and inconveniences."

If that was so, then the health ministry must reconsider its objections within two weeks and convey its decision to the court, the Bench said. An affidavit filed by assistant director-general (medical education) Mangla Kohli stated that the difficulties in a combined entrance examination were not insurmountable but required ironing out of lot of creases.

While the All India Pre-Medical/Pre-Dental Entrance Examination (AIPMT) is conducted to fill in 15% seats in MBBS/BDS courses in government medical and dental colleges against the all-India quota, the All India Engineering Entrance Examination (AIEEE) is for drawing up a combined merit list for different categories of engineering colleges. CBSE conducts both AIPMT and AIEEE every year.

Link: Original Article

Private hospitals must treat poor for free, says HC

Big private hospitals who got land at concessional rates in the city can't escape the obligation to provide free treatment to certain percentage of poor patients, the Delhi high court has said.

A division bench comprising Chief Justice Dipak Misra and Justice Manmohan on Thursday came down heavily on private hospitals shirking from extending free treatment to poor patients though it was one of the clause in the lease deed due to which land was given to hospitals at a very cheap price.

HC's comments came on a plea filed by a few prominent city hospitals like Ganga Ram and St Stephen's claiming that the 2007 landmark verdict of HC approving the free bed scheme wasn't applicable on them. The hospitals argued the lease deed with the government never made it compulsory for them to reserve free beds for 10% in the in patient department (IPD) and 25% in out patient department (OPD). They also pointed out how free camps were being held by the hospital administration to provide medical aid to the needy.

But the Land & Development Office of the central government through its counsel, Sanjiv Dube, informed HC that the policy of giving land at huge concessions to private hospitals has remained unchanged since 1949 with the basic premise that as a welfare state the government has a duty to ensure poor get free treatment.

The bench then warned that those found defaulting on 2007 HC ruling might even risk losing their lease deed and emphasized that private hospitals can't pick and choose patients, but its the government who can decide.

In 2007, HC had directed private hospitals, which had been given land at a concession in Delhi to provide free treatment including medicines to patients from families earning less than Rs 2,000 a month. The bench also appointed a special committee to monitor if hospitals adhere to the court order.

When the committee reported back that hospitals were deliberately shying away from honouring the HC verdict, the bench took a strong view and in one case, that of Apollo Hospital, even fined it for not offering free treatment to a poor patient.

Link: Original Article

November 18, 2010

India, Rwanda to cooperate in health care

India and the eastern African nation of Rwanda Friday signed a memorandum of understanding (MoU) on cooperation in the fields of health and medicine.

The MoU, signed by Health and Family Welfare Minister Ghulam Nabi Azad and his Rwandan counterpart Richard Sezibera, covers multiple fields like integrated disease surveillance, medical research, emergency relief, drugs, laboratory and diagnostics, and pharmaceutical products and traditional medicine.

According to an official statement from the health ministry, the cooperation will also extend to fields like hospital management, health tourism, telemedicine and training of human resource.

'The cooperation is likely to take form of collaboration in exchange of information in the field of health and medicine, exchange of experts in the field of health, health manpower development in the field of epidemiology and outbreak, diagnostic laboratory support through testing clinical samples during outbreak situation training in the mutually agreed identified areas, deputation of experts to attend international meetings held in either country, technical support in establishing laboratories/ hospitals and research in mutually identified areas,' a health ministry official said.

The Rwandan minister is on a short visit to India. The MoU comes as part of the growing bilateral ties between the two countries.

Link: Original Article

November 17, 2010

IGNOU launches diabetes training programme

The Indira Gandhi National Open University ( IGNOU) has launched a programme to train medical graduates in treating diabetes, it was announced here Wednesday.

The programme will be open to medical graduates looking to enhance their knowledge and skills in the area of medical diabetology.

IGNOU's School of Health Sciences (SOHS) signed a memorandum of understanding with Hansa Med Cell, a company working in providing medical education, to launch a PG diploma programme for medical graduates in diabetes mellitus.

'Flexibility and outreach are the two important strengths of the university. We hope to use these strengths for improving health care, especially to the poorest sections of society,' said P.R. Ramanujam, pro-vice chancellor of the university.

Srinivasan K. Swamy, group chairman of Hansa Vision, said: 'Diabetes has become pandemic today. The International Diabetes Foundation estimates that the number of diabetes cases in India has doubled from 19 million in 1995 to 40.9 million in 2007. It is estimated that by 2030, every fifth person with diabetes will be an Indian.'

'Hence we have taken up the herculean task of improving healthcare for diabetics in collaboration with IGNOU,' he added.

The course will be launched January 2011 and will be offered through IGNOU study centres as well as the centres of Hansa Vision.

Link: Original Article

Government proposes four-point agenda for population stabilisation

The Centre has proposed a four-point agenda for population stabilisation in the country which includes setting up a separate division in the Health Ministry dedicated to the cause.

These divisions would also be set up at the state, district and block level. This division will focus on providing access to services by co-opting the private sector and also undertaking advocacy efforts at the village level and upwards, the Health Ministry proposed at the latest meeting of the population commission.

Establishment of post-partum centres, which deal with post-delivery services, in all such facilities where institutional deliveries are being conducted, providing contraceptives at doorsteps through village ASHAs (health workers) and enhancing compensation for women undergoing sterilisation are the other steps which are being mulled.

Speaking at the meeting of the population commission recently, Health Minister Ghulam Nabi Azad said at present, the supply of contraceptives is made by the Central Government to the states.

"Most of the time these supplies do not reach below the district level. We, therefore, propose to introduce a new system under which contraceptives will be available at the doorsteps at the village level through the ASHAs (Accredited Social Health Activists) who are our community-based workers.

"This would enable the village community to have direct and easy access to contraceptives. Appropriate incentives for ASHAs to undertake home delivery of contraceptives are being worked out," he said.

Azad said the government was also proposing to substantially enhance compensation for women undergoing sterilisation from the current level of Rs 600.

The meeting of the commission was attended among others by Congress President Sonia Gandhi, Prime Minister Manmohan Singh, Harshvardhan of BJP, Sharad Pawar of NCP, Union Ministers Kapil Sibal, Ambika Soni and chief ministers of some states.

Experts suggested improved health care, availability of family planning services, literacy and empowerment.

To help the cause of population stabilisation, the Health Ministry has also zeroed in on population stabilisation as the theme in the health pavilion at this year's trade fair beginning here from November 14.

Link: Original Article

November 14, 2010

Doctors misleading patients liable to be prosecuted

Doctors misleading patients through false claims about their professional qualifications are liable to be prosecuted for rendering deficient service, the country's apex consumer body has held.

"It also amounts to unfair trade practice by doctors," the National Consumer Disputes Redressal Commission (NCDRC) said.

The NCDRC ruling came on a complaint by Meerut native Surendra Kumar Tyagi against local doctor S K Sharma, who claimed to be a Master in Surgery and operated upon him, allegedly damaging permanently one of his kidneys.

"Though the doctor proclaimed himself to be an MS (Master in Surgery), he was in fact not so qualified (and) that would clearly amount to misrepresentation to the complainant and others about his real qualification and experience," said an NCDRC bench of members R C Jain and S Chandra.

"This is another deficiency in service or what we can term as adoption of unfair trade practice -- unethical practice on the part of a medical professional," it said. Agreeing with Tyagi's contentions and findings of the Uttar Pradesh State Consumer Commission, the NCDRC enhanced the compensation to him to Rs 2.5 lakh from Rs one lakh awarded by the state forum.

Tyagi had approached the apex consumer forum to enhance the compensation awarded to him by the state in the case against Dr Sharma and Meerut-based Jagat Nursing Home and Hospital.

Allowing Tyagi's appeal, the Commission said the compensation in cases of misrepresentation and negligence by doctors should be proportionate to the loss and injury suffered by the patient and cannot be arbitrary.

"For the kind of negligence, deficiency in service and the misrepresentation made by the doctor, award of compensation of Rs 1 lakh only cannot be considered as reasonable or commensurate with the loss, injury and mental and physical pain and agony suffered by the complainant," it said.

Link: Original Article

Rampant sexual harassment of female doctors in Karachi by male staffers

Female doctors in Karachi have revealed that male paramedical staffers at Civil Hospital Karachi are harassing them, and it is causing serious mental stress among them.

The harassment is not limited to only female doctors but also female paramedical staff.

Newly appointed female doctors feel insecure while performing long hours duties in different wards, Outdoor Patient Departments, Intensive Care Unit and the operation theatres of the CHK.

"We are already working under poor and unhealthy living conditions at Civil Hospital," the Nation quoted a new doctor, who is completing her house job training at the General Patient Ward of Civil Hospital, as saying.

"The Staff Rooms available for the junior doctors lack basic facilities of safe drinking water, proper seating arrangement and clean washrooms.

"Nevertheless, the offensive behaviour of the paramedical workers cannot be tolerated by all means.

"We have brought this issue into the notice of hospital administration many times by informing that the male nurses and ward boys do not give proper respect to us.

"They annoy and threaten us verbally, psychologically and sometimes sexually without having any fear and accountability of the hospital management," she added.

Another trainee doctor revealed the junior doctors sometime face sexual harassment by the paramedical staffers.

Dr Samrina Hashmi, a former General Secretary Pakistan Medical Association Karachi Chapter, said there is a high-level of political interference in the public sector hospitals.

"The only way to get rid of this problem is to depoliticise public hospitals," she said.

"In order to improve the performance of the teaching hospitals, the Government should ban political activities in the premises of public hospitals.

"The healthcare institutions should be free from the interference of the political parties," she added.

Link: Original Article

November 13, 2010

Issues over electronic medical records' outsourcing plan

While many of the Indian IT companies have been eying the awaited wave of the US spending to digitize the health care records, but the recent issue where many have shown sensitivity towards this issue over the resistance shown by the American hospitals in sending medical information overseas could thwart efforts to win big contracts have emerged as a big issue in its path.

It is to be mentioned here that the US government is planning to spend billion, of dollars on the health care providers that will be ready with the electronic medical records and doctors operating in the economy will also be facing a federal mandate under which they will have to upgrade software as the U. S. switches to a new system of insurance billing codes.

However, for the Indian companies having a huge experience in the field of software outsourcing, the opportunities are the US healthcare sector is like another leap of growth for the sector. Pradep Nair, head of the health-care practice at New Delhi's HCL Technologies Ltd. Said that this is like another Y2K opportunity.

Link: Original Article

Teachers' shortage for Community Medicine

Low salaries and lack of teachers have resulted in less than the desired level of attention being paid to Community Medicine, an important subject taught to students of medicine, nursing and pharmacy. Also, the subject comes under the control of two departments.

The Institute of Community Medicine in the Madras Medical College that offers a postgraduate degree (MD) in the subject and a PG diploma in public health has only four qualified professors against the sanctioned strength of 15. MMC, the only government-run institution in the State to offer the course, admits four students every year. Two of the seats are reserved for private college students.

Trained community medicine experts develop strategies to improve public health and are involved in ensuring sanitation of the entire community. “When four people have diarrhoea, it is a medical problem but when 100 people have it, it becomes a public health issue,” explained an assistant professor in the Institute. “As we are woefully short of faculty members we cannot take more candidates,” he added. “We are not allowed to practise outside. Neither are we compensated with special allowance. The result is nobody wants to become teachers,” he said.

Considered a “rare” branch of medicine, the subject comes under the Directorate of Public Health and the Directorate of Medical Education. While the DPH absorbs diploma holders as field workers, those who have finished the PG course become teachers. As the pay anomaly for the teachers has continued for several decades, the development of prevention strategies has also suffered, a senior Health department official said. He suggests that at least 25 per cent of the salary be given as non-teaching allowance.

According to MMC Dean J. Mohanasundaram, lack of staff in non-clinical subjects is due to a sudden spurt in medical colleges in the State. But with private colleges also offering the course, the vacuum will be filled when the present batches of students graduate. V.K. Subburaj, Principal Secretary, Health, said the salary of every section of the medical field had been increased. “We cannot increase the salary for one speciality as against the other. However, we will have a discussion with them and try to sort it out,” he added.

Link: Original Article

November 12, 2010

MCI Watchdog outlaws IMA endorsements

The Medical Council of India (MCI), the statutory body regulating medical education and practice, has found unethical the Indian Medical Association's endorsement of two food products and barred such endorsements. MCI board member Dr Ranjith Roy Choudhary told TOI the council would ask IMA, an association of 2 lakh doctors, to stop endorsements.

''We have decided to ask IMA to stop such endorsements forthwith. Penal action, if any, will be decided by the MCI ethics committee at its meeting. The decision will then have to be ratified by the board of directors the next Tuesday,'' he said.

IMA honorary secretary-general Dr Dharam Prakash said the association was yet to hear the final word from MCI. ''We haven't got any official communique and hence we have not decided anything on the contract,'' he said.

The issue is the medical association's Rs 2.25-crore contract with Pepsico to allow Tropicana fruit juice and Quaker oats to use the IMA logo on their packs for three years ending 2011. The controversy has been raging for two years after Dr K V Babu, an IMA central committee member, complained to MCI on June 6, 2008, that the endorsement violated medical ethics. After protracted proceedings, the National Human Rights Commission served a notice on the association on June 30, 2010.

After some confusion on its own powers over IMA, MCI on August 18 declared that IMA came under its jurisdiction and served a show-cause notice to the association ''for endorsing the product in violation of the provisions of the Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002.'' In its reply of August 30, IMA argued it had not endorsed the products, but only entered into an MoU with Pepsico for a 'nutritional awareness programme.'

MCI found this explanation unsatisfactory and summoned IMA honorary secretary- general Dr Dharam Prakash for a personal hearing and inspection of the MoU. ''Now it is clear that IMA was at fault by endorsing the products. If the endorsements have not yet been stopped, they have to be, soon,'' Dr Choudhary said.

Earlier, speaking to TOI, IMA office bearers had said the decision to endorse the products was a mistake, but it was unable to get out of the contract as the settlement amount would be too big.

In a similar case in 1988, the American Medical Association (AMA) had to pay $9.9 million (Rs 45 crore) to withdraw from a contract it signed with Sunbeam Corporation. While that was an endorsement of medical equipment, IMA became the first professional body of doctors in the world to endorse a food product. In fact, IMA has endorsement contracts with health and hygiene products including Dettol, Lizol (sanitizers), Aquaguard (water purifier), Pampers (napkins) and Odomos (mosquito repellent).

Read more:

Link: Original Article

November 11, 2010

IIT software to cut down cost of medical tests

Promising some relief to those spending a considerable amount of their income on hospitals bills and medical tests, the rates of MRI, CT scan, X-Ray and ultrasound tests are set to come down by next year. This will be possible with development of a software by IIT Roorkee in a joint project with PGI Chandigarh.

The software, which will be installed in these diagnostic machines, will be able to easily pick up any abnormality in ultrasound, MRI, or a CT scan. An analytical data has been saved in the software according to the texture and various signals from these image tests. Comparing an abnormal scan or ultrasound with the standardised data generated in the computer will make it possible for the medicos to identify the disease, said professor and head, electrical engineering department at Roorkee IIT, Dr Vinod Kumar.

This is the first IIT-PGI project. The database provided in the software will suit diseases pertaining to our country. "The present software has to be imported, which shoots the rates of these tests. We will provide this software free of cost to public centres like the PGI and AIIMS," noted Vinod.

The IIT has already worked on ultrasound for liver and has reached the second phase of trial in interpretation of the data for a CT and MRI in combination. Head of the radio diagnosis at PGI, Prof N Khandelwal said, "This is going to reduce the price of these diagnostic imaging tests as the software is indigenous. In addition to this, any doctor at a primary health centre can prepare a provisional report without consulting secondary or tertiary level hospitals."

"Any area where the malformation is suspected can be highlighted, zoomed, increased in brightness easily for treatment planning. There is no need for a super specialist to record the readings while preparing a report for the imaging. The parameters in the software can be matched with the patients scan with ease," added Vinod.

Cost of a CT scan ranges between Rs 350 and Rs 900 at PGI while at GMCH the rates vary from Rs 550 to Rs 2,500 depending on the body parts.

Link: Original Article

November 10, 2010

Doctors up against Clinical Establishment Act

With the state government seriously considering regulation of private hospitals by making registrations mandatory, doctors associations in the state are gearing up to coax the health department into relaxing certain norms.

The Indian Medical Association on Saturday held a symposium, raising at least six objectionable points.

The Tamil Nadu Private Clinical Establishment Act came into force in April 1997, but the Act could not be enforced as the state did not frame rules. But after the Clinical Establishment Bill, 2010 was passed by Parliament on May 3 by vote of voice without discussion, the state health department is holding discussions on whether it should adopt the state Act or the Central Act.

Health minister MRK Panneerselvam said he would consider the recommendations by doctors associations, without compromising on accessibility and safety. Health secretary VK Subburaj prefered stringent regulations. The state Act is more powerful than the Central Act, he felt.

At present, private hospitals are not required to register with the government, and cases of medical negligence are dealt with by consumer courts. The legislation is to ensure all hospitals are registered with the state government, they have doctors and nurses to match the beds strength, carry out procedures based on its infrastructure and create registries for diseases and form committees to conduct infection and death audits.

Indian Medical Association honorary secretary Dr TN Ravishankar said the main objection to the new Act was regarding Section 10 (1) which says that the state government shall, by notification, set up an authority to be called the District Registration of Clinical Establishments, with the district collector as the chairperson and the health officer as convener. "In subjects related to medicine, competent authority should be none other than a doctor. We want representatives from our association in every such committee," he said. The Act, he added, also gives more scope for bureaucrats to misuse power. "There is no reason why fines should be as high as Rs 50,000 to Rs 5 lakh. When the state frames the rules to implement the Act, we want to ensure that they are not draconian," he said.

Link: Original Article

November 09, 2010

Health Ministry opposes combined entrance test

The Union Health Ministry on Friday opposed in the Supreme Court the Human Resource Development Ministry's move to introduce an all-India combined entrance examination for admission to engineering and medical courses from 2011-2012.

A Bench of Justices R.V. Raveendran and A.K. Patnaik issued notice to the Health Ministry, seeking its submissions in writing within three weeks.

Senior counsel Altaf Ahmed, appearing for the Central Board of Secondary Education (CBSE), which filed the application, said the combined examination would relieve students from taking multiple examinations. When Justice Raveendran asked whether there would be separate counselling for admissions, the Health Ministry counsel said that even if there was separate counselling for engineering and medical courses, there were certain practical and logistical difficulties in holding such an examination (combining the All India Engineering Entrance Examination (AIEEE) and All India Pre-Medical/Pre-Dental test). He said it would be premature to go ahead with such a combined test.

Justice Raveendran asked counsel, “Are there difficulties or is it a departmental fight between the Ministries. You put everything in writing.”

In its application, the CBSE said the All India Pre-Medical Test was conducted to fill 15 per cent seats in MBBS/BDS courses in the all-India quota and the AIEEE conducted for different category of engineering colleges.

The CBSE said the Centre held a meeting on October 10 with itself, the Delhi University and the Medical Council of India where the decision to hold a combined test was taken.

The CBSE sought the court's nod for this proposal. The Bench directed the matter to be listed after three weeks.

Link: Original Article

November 08, 2010

Doctors will now have to write prescriptions for antibiotics in duplicate, one copy of which will have to be retained by the chemist for a year from the date of sale in order to facilitate verification and audit.

The decision, made by the Drug Controller General of India (DCGI), India’s national drug regulator, is aimed at preventing the widespread misuse and overuse of antibiotics, which was recently blamed for the evolution of the new ‘superbug’ NDM-1, resistant to even the most powerful group of antibiotics.

The DCGI also decided to create a separate schedule for antibiotic drugs under the Drugs and Cosmetics Act to effectively enforce this decision.

The Indian Express had reported on Wednesday that the Health Ministry was planning to put antibiotics under a separate schedule, and make it mandatory for them to be sold only against prescriptions.

“These steps are expected to act as deterrents for doctors and chemists who prescribe antibiotics unabated,” Dr Surinder Singh, DCGI, told The Indian Express today.

Violations will be punished by a fine of at least Rs 20,000 and imprisonment of a year, which may be extended to two years. “Drug inspectors can go and check chemist shops. Violators can then be taken to court,” Dr Singh said.

At the Drug Consultative Committee meeting with drug inspectors, a consensus was reached on placing antibiotics under a new schedule called HX. Some 50-60 antibiotics will be placed under Schedule HX, along with 15-20 anti-TB drugs and 10-15 habit-forming drugs like cough syrups that contain codeine.

“TB resistance is becoming quite common, that is why it was decided to keep an eye. Duplicate prescriptions will also be needed for all cough syrups containing codeine, and anti-anxiety drugs too,” Dr Singh said.

Prescriptions in duplicate are currently needed only for drugs under Schedule X of the Drugs and Cosmetics Act and Rules. The most commonly known drug under Schedule X is Oseltamivir Phosphate or Tamiflu, prescriptions for which are supposed to be retained for two years by chemists.

“The new Schedule HX will be a little relaxed than the existing Schedule X, but it will be stricter than Schedule H,” said an official.

The recommendations of the Consultative Committee meeting will now be sent for notification to the Union Health Ministry, which will then have to be ratified by the Drugs Technical Advisory Board (DTAB) within a period of six months.

A task force constituted by the Ministry under Director General of Health Services (DGHS) Dr R K Srivastava, which includes experts from India’s top medical institutes, is likely to meet soon to decide on a range of other measures for regulate the use of antibiotics in the country.

The experts have already proposed that hospitals should mandatorily set up a “drug control committee” to approve high-end antibiotics and an “infection control committee” to track and analyse infections. “High-end antibiotics like carbapenem, imipenem and meropenem should be prescribed only after the committee gives the go-ahead,” said a senior Health Ministry official.

DRUG CONTROL RECOMMENDATIONS

Prescriptions in duplicate-Antibiotics under a separate Schedule:

*Prescription audits’ every six months

*‘Drug control’ and ‘infection control’ committees in government hospitals

Link: Original Article

Health cover may include ayurveda, unani, siddha

A panel formed by the insurance council will probably recommend that domestic healthcare systems such as ayurveda , unani and siddha should be treated on par with allopathy when it comes to medical insurance, said a person familiar with the committee’s thinking.

“The department of Ayush has approached the General Insurance Council for looking at the possibility of accepting claims under the non-allopathic means of treatment,” said a person familiar with the development at the Council. “They made a presentation to council members, who in turn, have formed a three-member committee to look into the matter.”

The committee comprises chief executive officers from Star Health, Max Bupa and Apollo, the person said. It would examine the merits and demerits of the proposal and recommend processes to implement if it is convinced that these types of medicines should also be covered under health insurance. The Insurance Regulatory & Development Authority will take a call on the issue.

A large section of India’s more than a hundred crore population takes alternative means of treatment which is recognised by the government, but not so far by the insurance industry. Insurers where most of them are in a joint venture with a global company, say there is not an established way to verify these claims and no data to rely on.

“Under allopathic means of treatment, there are scientific studies and we know how long a treatment will take, how much will it cost,’’ said TA Ramalingam, head of underwriting, Bajaj Allianz General Life Insurance.

“But under the alternative means like homeopathy, we do not have enough data to cover them. For example, curing an ailment under homeopathy may take years, we would not have a structured way of looking at data. But under allopathic means of treatment, it’s more immediate, and hence, easily manageable.”

There is no registration for practitioners of alternate means of treatment either. There is no one body that recognises the institutes/hospitals that treat patients.

But the health and family welfare ministry is pushing hard for it as it is affordable and the majority of the population makes use of the domestic expertise in these areas. Allopathic medicines are expensive even for those who are in urban centres.

The Department of Indian Systems of Medicine and Homeopathy was created in March 1995 and re-named as Department of Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homoeopathy, or Ayush, in November 2003 to develop education & research in those fields.

Link: Original Article

November 06, 2010

Revenue Recovery Looms Over Rural Posting Defaulting Doctors

Doctors who have not served the one-year Compulsory Rural Service (CRS) will have to pay the government at least Rs. 30 lakhs each, according to National Rural Health Mission (NRHM) officials.

Plans are under way to also cancel the Medical Council Registration of these doctors.

These punitive measures are being chalked out to make sure that students who complete the MBBS/Medical PG degree/DNB or Diploma from government-run medical colleges serve in the rural areas to fulfil a contractual obligation to the government.

Primary reports show each defaulting doctor has to pay not less than Rs. 30 lakh, which includes the bond amount and the amount spent by the government on each doctor during the course of studies and the interest on this amount.

In Kerala last year, 528 doctors were sent for CRS out of which 201 have discontinued without giving proper reasons. “We have sent notification to 160 of them asking them to resume service. Notifications for the rest are in process. And if they don’t turn up, revenue recovery by the government will happen without any compromise,” says a senior official at the NRHM in Trivandrum.

Students are given admission for MBBS, only after they sign a contract with the government for serving in rural areas for one year soon after completion of their course. There is also a provision to discontinue their service if they get admission for higher studies but they should resume service after the course.

But the practice now is that many of these doctors refuse to do rural service but join private hospitals or go abroad soon after the completion of their course. Also, junior doctors go on leave for preparing for PG admissions. This creates a dearth of doctors to attend to the poor and needy in the rural areas.

One of the reasons the doctors give for not taking up rural service is the low remuneration.

“It has become a regular practise by the doctors to not take up the rural service. These young doctors complete their MBBS at an age of 23 or 24 when students in other professional streams like engineering start earning at 22. By the time these engineers are 24 or 25 they become rather settled in life with a good job in hand and probably even a marriage, whereas an MBBS student has to go for higher studies. It makes it difficult for them to take up another year of rural service due to their personal commitments. Hence the defaulters,” says a senior doctor from Trivandrum Medical College, who doesn’t want to reveal his identity.

The NRHM now offers Rs. 15,000 per month as salary for the doctors who take up rural service. Also, they can avail 20 casual leaves and one leave every week. In addition to all this, doctors who are posted in interior rural areas such as Attapadi and Parambikulam are given an extra allowance of Rs. 3,000 to Rs. 5,000.
Pay-back Time

The students who pass out of government medical colleges owe it to the government to pay back in some form. “I think the government is right in their decision. The rural posting is the government's way of reclaiming the money that they spend on each student in a government medical college. If you look at the figures, a student in a government medical college pays an annual fee of around Rs. 12,500 as against about Rs. 5 lakh paid by a student in a private medical college. The rest of the amount is borne by the government,” says a student of Jubilee Mission Medical College & Research Institute, Trichur.

One year of rural service is not much in terms of a junior doctor’s pay-back to the government. Besides, a doctor who does rural service gets preference when he or she applies for PG courses.

“There is also another side to this story. Most of the students who get into the government medical colleges are repeaters at the entrance. Hence, most of them would be 24 to 25-years old when they graduate. And then they have their PG to do. So, obviously, they don’t want to ‘waste’ another year in rural service.”

“But rural service is a humanitarian service that a doctor owes to the society and there shouldn't be defaulters. Even we (students of private medical colleges) have something called ‘community service’ wherein we will have to visit rural areas on a regular basis,” he adds.

Reasons To Bunk

A house surgeon at the Alappuzha Medical College has a different take on the whole issue. “Though I would not support this practise by doctors, we have valid reasons for doing this.”

He blames the government’s erratic administrative behaviour for doctors being in a precarious situation. “It’s the government that decides who will be posted where and when the posting must be made. Most of the time what happens is that no decisions will be made by the time we complete our course. The next thing we would like to do is to go for a PG or take up a posting somewhere we will be paid a decent salary. But we can’t take up a job because we will be waiting for our rural postings,” he says.

“The rural posting comes when we least expect it. It becomes practically impossible for us to plan our lives with such erratic behaviour from the government.”

Another issue that he points out is that two batches complete their courses at nearly the same time with the results of the previous batch coming late. And there are rumours that the NRHM doesn’t have enough funds to pay the doctors of two batches if they get posted at the same time. “The latest batch would get a posting at a later time and no one gives us any assurance when this posting happens. Hence it becomes most likely that some of us would try to evade the rural posting,” says he.

But the officials at the NRHM office near the General Hospital here wouldn’t buy these arguments. “It’s not true that the doctors can’t choose where they would like to get a posting. We give postings strictly on merit basis. Those who pass the course with top ranks can choose where they’d like to do their CRS. Obviously, those who come last in the rank list will be left with not many options,” says a top official at the NRHM.

He says the department doesn’t delay postings. “Doctors usually complete their course by October-November every year and we send them posting notifications by December or by the end of November itself. There is no question of them having to wait for long. If there are late postings, it is only because some of them would have papers to clear and they finish the course after the others,” he adds.

He also rubbishes the rumours that the NRHM is running out of funds. “I’m not aware of anything like that. The NRHM is a fully state-run institution funded by the central government. We currently pay Rs. 15,000 for each doctor, Rs. 3,000 extra for those posted in ‘difficult rural areas’ and Rs. 5,000 for those posted in ‘most difficult rural areas’. And we have always been prompt in paying the salaries. About the pay being less, I’ve no comments. It’s the state government that decides the remuneration,” he says.

Doctors who go for rural service don’t have many good experiences to share. Most of the time, the senior doctors would dump all the responsibilities on the junior doctors. This is also a reason for some of them not returning once they get a chance to step out to do a PG course.

Having listened to all sides of this issue, Yentha believes that it’s a matter of professional ethics Vs practicality. The government’s decision of revenue recovery is something that can be justified in many ways and yet, one can’t be oblivious to the issues raised by the doctors.

A senior doctor of Trivandrum Medical College says: “Someone taking up medicine as a career has to be aware of these professional hazards rather than running away from responsibilities.”

Unlike in other professions, an irresponsible medical practitioner puts the life of common man at stake. Medicine is a profession where one’s priority should be the welfare of the people rather than any personal benefits.

An excerpt from the modern version of Hippocratic Oath: I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.

Link: Original Article

TN to have health data resource centre soon

Tamil Nadu will soon have a centralised data resource centre to collect relevant data across all health departments.

The Health Management Information System (HMIS), accessible across the various departments, will be able to function as a one-stop shop for all information on health in Tamil Nadu, and as such will be able to influence policy-making in the health sector, according to S. Vijayakumar, project director, Tamil Nadu Health Systems Project (TNHSP).

Once it is through, it is likely to be the first such system in the country, Principal Secretary, Health, V.K. Subburaj told The Hindu. He added that two months down the line, the skeleton of the system should be in place. To be implemented as part of the TNHSP, in association with AIDS Prevention and Control Project and the State government, the health data centre would bring about the much-needed interlinking between various health verticals.

“There are 18 different verticals in the health sector in Tamil Nadu, for instance – the Directorate of Public Health, Directorate of Medical Services, Tamil Nadu State AIDS Control Society, Blindness Control Society. Each department has its own reporting system and there is no interlinking between them,” explained P.K.Amarnath Babu, State co-ordinator, HMIS.

The new data resource centre will liaise with all these departments, identify the reporting structure, streamline it electronically, and thereby collect data from all these various sources. IT-related analytical tools will then be applied to churn out statistics and indicators that will be helpful in formulating or changing health policy.

“It will be useful to map development indicators of the State on a constant basis. We can also generate data to evaluate where Tamil Nadu is in terms of meeting the Millennium Development Goals,” Dr. Amarnath said. In addition, it will be useful to various departments, hospitals and PHCs purely as a measure of routine supervision and achievements in the short and long term.

Aggregated data will be updated constantly. Individual patient data will not be available on a system, except in some cases such as maternal deaths, deaths due to infectious diseases will be recorded with contact details of patient's family. On the manpower front, details such as retirement dates of staff across various departments can be generated with a simple command.

A private agency, CNSI, has been contracted to do a two-month study on the existing reporting structure and to understand the nature, value, and utility of information collected. By the end of November, the agency will hand over a blueprint for an operations manual, which will include a software requirement specification for developing the HMIS. Armed with that business and technical plan, another agency will be hired to write the actual information system.

Already, 1,500 primary health centres have started reporting entirely through the MIS, with the manual reporting system being phased out.

The DMS will also start the process of digitising the reporting system soon. The TNHSP will make infrastructure enhancements wherever necessary, Dr. Amarnath Babu added.

Link: Original Article

November 05, 2010

DNB degree-holders can now teach medicine

Doctors with a Diplomate of the National Board of Medical Examinations (DNB) degree can now teach in medical colleges.

In a major decision, the Union health ministry has approved the Medical Council of India's (MCI) proposal to allow doctors, who have a DNB degree, to teach just like those with a MD/MS degree.

The move will help the nation to 3,000 new medical teachers who obtain a DNB degree in 54 subjects. Till date, DNB was never recognized on a par with other PG medical degrees like MD/MS.

The latest rule will allow those DNB degree-holders, who have been teaching for several years to be automatically recognized as faculty members. Those doctors who pass out with a DNB degree from a medical college will get the same status.

However, DNB degree-holders who have passed out from private or non-MCI recognized medical colleges will have to have experience of an additional year of senior residency in a teaching medical institution to be on a par with a qualified MD/MS candidate.

Dr Gautam Sen, MCI board member, told TOI, "This is primarily because those with MS/MD degree from a medical college have the experience of teaching undergraduate students when they are senior residents. A DNB doctor does not have such a teaching experience." Dr Devi Shetty, another MCI board member, added that the new rule would increase India's pool of medical teachers in a big way. "The ministry has been wanting to allow DNB doctors to teach. However, earlier the MCI board didn't approve it. DNB doctors can not only start teaching but also perform surgeries soon after passing out," Dr Shetty told TOI.

Dr K Srinath Reddy, president of the National Board of Examinations (NBE), which grants DNB degrees, welcomed the ministry's decision. However, he harbours few concerns. He told TOI from Boston that "while an additional year of senior residency has been recommended for a DNB doctor passing out of a private or non-MCI recognized medical colleges, it is difficult to envisage how medical college hospitals will offer such a limited period of senior residency when they would prefer to select candidates for a full three-year period.

Further, candidates, who have done DNB in super specialities like cardiology or neurosurgery, are unlikely to go in for an additional year of senior residency." With regard to teaching and research experience, Dr Reddy added that DNB now has a compulsory thesis while DNB training hospitals do not usually provide their candidates with undergraduate teaching experience.

"There are also several medical colleges which don't have UG component such as SGPGI, Lucknow; and PGI, Chandigarh. Therefore, absence of an UG teaching experience should not be a disqualifier," Dr Reddy said.

Link: Original Article

November 04, 2010

Now medical colleges on Public Private Partnership model

In a decision that will radically change medical education in the country, the Medical Council of India ( MCI) gave its go-ahead to upgrade district hospitals to medical colleges across the country.

The apex body told the Union health ministry to relax norms for starting new medical colleges in areas with poor healthcare access and limited seats to study medicine. About 100 colleges will come up in the next two years.

Currently, 64% of colleges are in western and southern India and 54% are in private hands. The decision to start colleges in PPP models is designed to fight the shortage of doctors. "Most district hospitals already have 200-500 beds and by roping in private players, medical colleges can also be set up," a member said.

Link: Original Article

November 03, 2010

World Bank gives many bouquets, few brick bats to TN World Bank gives many bouquets, few brick bats to TN health sector

Tamil Nadu has rushed to celebrate a World Bank news letter profiling its health sector achievements in a cover story, but a closer look of the report story in the September issue of World Bank in India' reveals that the global funding agency has also highlighted several deficiencies in the state's health delivery system. In fact, the article was contributed by Tamil Nadu Health Systems Project.

Health secretary VK Subburaj on Monday issued a press release along with a copy of the article. The story titled Tamil Nadu shows the way in tackling some of India's most pertinent health issues,' credits the state with having led the nation in building a strong foundation for public health services and being a trendsetter in maternal and neo-natal care. However, the portion where it compares maternal and infant mortality rates with Sri Lanka and Kerala, is unflattering.

"There has been a 35% reduction in infant mortality rate from 48 per1,000 live births in 1999 to 31 per1000 live births in 2006, although additional efforts are needed to bring Tamil Nadu's infant mortality rate closer to better-performing neighbours such and Sri Lanka (18.8 per 1,000 live births and Kerala (14 per1,000 live births)," it said. On maternal mortality, it said "despite the fact that the state's ratio continues to be 25 times higher than in developed countries, according to sample registration system, maternal mortality rate has decreased from 167 deaths per 100,000 live births in 1999 to 111 per 100,000 in 2006."

It has quoted experts including former health secretary Sheela Rani Chunkath, who is now the chairman and managing director of Tamil Nadu Industrial Investment Corporation Limited, former director of public health Dr Padmanabhan and Vijayakumar, project director of the Tamil Nadu Health Systems Project and senior public health specialist Preeti Kudesia.

It applauds the state's effort in getting 99.5 % of women to deliver at a hospital or a healthcare centre, gearing up transport of women in labour through 108 ambulance services, 24-hour specilised clincs equipped with operation theatres, blood banks, intensive care units and diagnostic labs. It also highlighted better nutrition, vaccination coverage in children and pregnant women, and extended health services through a network of district and taluk level hospitals, primary health centres and health sub-centres in rural areas.

The report mentions two unique schemes, a pilot project in Sivaganga and Virudunagar for prevention and treatment of cardiovascular diseases and automating processes and online data management of 41 government hospitals through the health management information systems.

Link: Original Article

November 02, 2010

Supreme Court seeks response on common test for medical courses

The Supreme Court today sought responses within four weeks from the Centre and all states and union territories on the plea by Medical Council of India seeking to start single eligibility-cum-entrance examination for MBBS and post-graduate medical courses in the country.

A Bench comprising Justices R V Raveendran and H S Gokhale issued notices to the Centre and all state governments and union territories.

The court’s order came after MCI filed an application seeking impleadment of all states and union territories as parties to the writ petition seeking a common entrance examination for admission to MBBS and post—graduate medical courses.

However, the Bench said before passing any direction, it has to hear various stakeholder as state governments, private medical colleges and those run by the minorities may have some objections.

The Bench began by asking the MCI counsel and senior advocate Amrender Sharan as to “who is going to conduct the examination”, to which he said CBSE has been authorised for the purpose.

He said the candidates will be given a national as well as state ranks and 50 per cent of the seats would be for general candidates while 40 per cent will be reserved for quota candidates who will be given rank separately.

At this point, the Bench wanted to know about the candidates for the states.

Senior advocate Ashok Desai, who was appearing for Tamil Nadu, said it already has a common entrance test for colleges in the state.

The Bench also wanted to know from MCI as to “how can it deride the rights of the private medical university to hold entrance examination“.

Further, the Bench said there are certain minority institutions like Christian Medical College which conducts its entrance by itself.

“What is the hurry,” the Bench said and permitted MCI to implead states as party to the petition.

“Your intention may be noble but we have to hear all parties including private colleges,” the Bench said adding the CMC and other minority institutions have been holding their entrance tests for the last 50 years.

During the last hearing on Septemeber 17, the Centre had told the bench that it had approved the proposal of MCI for amendment of regulations relating to a common entrance test for medical courses.

Link: Original Article

Madras Medical College plans to tie up with US University

The Madras Medical College (MMC) is exploring the possibility of a tie-up with Oregon Health and Science University, Portland, U.S. to facilitate faculty and student exchange and improve research programmes, learning experience and international exposure.

As an Initiative to this proposal, U.S. Consul General Andrew T. Simkin and Health officer at the U.S. Consulate, Mrs. Deborah Edwards visited MMC and the Government General Hospital recently. The visitors were taken a tour within college, including the heritage building and the hospital building. This visit was organized and arranged by MMC’s Alumni Association and Friends of USA.

The Consulate members held a meeting with the heads of various departments in the Government General Hospital, which was attached to the Madras Medical College. Higher officials of the college Principal Secretary, Health, V.K. Subburaj, Dean J. Mohanasundaram were present for the meeting.

This move is expected to benefit both the Madras Medical College and the American University, says a Health official from both nationalities. While the Government General Hospital here will provide the clinical material and syllabus for their students, the foreign university would provide hi – tech technology input to help improve treatment modalities and ultimately research, says Dr. Mohanasundaram.

“The tie – up between two Governments owned hospitals in both countries is the first of its kind, there had been no such tie – ups happened before” said Mr. M.K.Ranganathan, President of Friends of USA.

“Initiated by G. Viswanathan, founder-Chancellor of Vellore Institute of Technology, the meeting was arranged in Chennai “to formalize a MoU during the visit of US President Barack Obama,” he added.

This MoU will also focus even on analyzing the data and information. This tie – up would provide Indian doctors a platform to prove their expertise in treating challenging cases, which would be projected through international medical journals.

Link: Original Article

November 01, 2010

Medical fraternity takes a shot at management

The MBA craze has hit the medical community too. From veterinarians to pharmacists, this year the CAT pool has quite a few aspirants from a medical background. About 2421 applicants are from the biology stream. Although it is a mere two per cent of the total aspirant pool of 2,04,267, it signifies a larger trend of people from diverse backgrounds wanting management degrees.

While 528 applicants are from the medical and dental fraternity, 1828 are from the pharmacy and microbiology background. In all, 65 veterinarians have applied to take the test. The registration data was released by the IIMs on Thursday.

“Medical insurance is set to become a very big industry and with a private hospital boom even hospital administration is very lucrative. Currently, people with either a medical or management background manage these portfolios. Medicos who combine their skills with a management degree will be in demand in the industry,” said Arks Srinivas from T.I.M.E, a coaching institute.

Engineering students form, as usual, the largest chunk of aspirants with 1,22,837 applying. This is followed by the commerce graduates (30,248) and business management graduates (21,809). Majority of applicants, about 74 per cent, are males. About 78 per cent of the people who have applied have less than one year work experience and a majority of them are fresh graduates.

Link: Original Article

Malarial deaths in India grossly underestimated by WHO, says Lancet

The number of deaths per year is almost 1,25,000, much more than the 15,000 estimated by WHO

How many people die of malaria every year in India? According to the estimates of World Health Organisation (WHO), 15,000 (10,000 adults and 5,000 children) malarial deaths occur each year.

But a study published online on Oct 21 in The Lancet points out that the numbers could be as high as 2,05,000 per year. The upper limit is around 2,77,000 and the lower limit is nearly 1,25,000.

This number for India alone is much higher than WHO's estimate of 1,00,000 deaths per year worldwide.

TREND ALREADY SEEN

The study underlines the fact that WHO estimates are a gross underestimation. Several studies in the past have shown that the number of deaths is more than WHO estimates.

The reason could be that WHO takes into account only those deaths that have been confirmed cases, and restricted to those seeking healthcare facilities. Also, the statistics are limited to a few high prevalent States (Orissa, Chhattisgarh, Jharkhand) and northeast.

Can the results from small studies undertaken in select States or in select subpopulations, and only from those families that had access to healthcare facilities be extrapolated to arrive at a national estimate?

Indeed assessing national estimates for malaria is challenging given the many limitations.

The paper shows how wrong the estimates can be if the current protocol is used. For instance, The Lancet paper shows that the majority of deaths occur in rural areas and in people who do not seek medical assistance.

EASILY PREVENTABLE

It must be remembered that deaths due to malaria can be easily prevented with prompt treatment, and those cases that are diagnosed properly will not result in deaths.

The authors used full-time non-medical field workers trained by the Registrar-General of India to interview the families where deaths have happened.

The procedure was followed in 6,671 randomly selected areas to find the cause of death of 1,22,000 people during 2001-03. Two physicians then had to confirm the cause of death based on the data provided by the fieldworkers.

Of the total number of deaths, 2,681 were found to be due to malaria. 90 per cent of these deaths had happened in rural areas and 86 per cent were not in health-care facility.

STUDY LIMTATIONS

The study indeed has some limitations, though. The authors agree that their study has a degree of “uncertainty” as the cause of death is deduced in those people who were never properly diagnosed or treated. “The major source of uncertainty in estimates arises from the possible misclassification of malaria deaths as deaths from other diseases, and vice versa,” they state.

The comment piece in the same issue of the journal notes that “deaths from malaria are predominantly unnoticed by the health-reporting system.”

The comment piece goes further to state: “Many workers have also noted that the health management information system in India is not fit for the purpose of recording malaria morbidity and mortality.”

The study underlines that true estimates of malarial deaths in India remain uncertain. In any case, WHO estimates, both for India and worldwide, are way off the mark.

The implications of such gross underestimation are unimaginable. For one, it results in complacency and wrong disease control strategies. If the numbers are indeed much higher than WHO estimates, then serious re-evaluation of disease control strategies is required.

Also, as the authors note, there is an urgent need to concentrate on rural areas where healthcare facilities are poor. At a global level, it calls for enhanced funding to fight malaria, efforts to develop easy and rapid access to better diagnostics and effective drugs.

Link: Original Article

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