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Discussion Starter · #1 ·
I'm not sure if we have a thread of this nature but I certainly believe we need one. India has a gigantic population and its healthcare industry has to rapidly expand to improve the standard of living.

Personally I'm doubting private healthcare as the way to go. I think these services should be in the hands of an able government. But as an able government is far from reality privitization may just be the only option.

Here's a nice article I came across to start this thread:

Healthcare goes five-star...
Radhieka Pandeya / New Delhi December 2, 2006
Naresh Trehan

...not because private hospitals are elitist but because of the quality of their services. No wonder big money is flowing in.

Wearing a plain brown sari and a gemless gold ring, Vandana sits patiently in the swank, white-and-green lounge of a private hospital in Delhi. Her only other piece of jewellery is a gold bangle worn over four red glass bangles.

A black knapsack rests at her feet. “My husband has a kidney problem,” she says slowly. “He is being treated at AIIMS (All India Institute of Medical Sciences) but the doctors there asked us to get his dialysis done at a private hospital.”

Vandana and her husband have travelled 116 km from Muzaffarnagar and are happy with the service and attention they are receiving at the private hospital — Max Balaji, recommended to them by AIIMS and a family member who was operated on there.

Vandana and her husband are part of a movement the private healthcare sector is witnessing in India. Though the trend started with Apollo Hospitals in Chennai many years ago, it is picking up at mindboggling speed.

Healthcare is the new buzzword for corporates and individual businessmen alike, with many corporates setting up private hospitals under their banner. Private healthcare has grown into a formidable industry with an estimated worth of Rs 80,000 crore (CII estimate).

The result: hospitals that don’t resemble hospitals, machines that were once unheard of in India and services that can match any five-star hotel. Yes, the Indian healthcare industry is getting an extreme makeover and is touching the lives of people not just in India but all over the world.

According to a CII study, with demand exceeding supply, the industry is expected to continue its upward run at a rate of 13 per cent annuallyfor the next six years.

The last five years have witnessed the evolution of very large corporate hospitals that don’t stop at just a single unit. So you have Max Healthcare setting up six hospitals in Delhi alone, Wockhardt setting up 10 across the country, Apollo Hospitals going international and Fortis Healthcare running 12 hospitals in north India, with more in the pipeline. Indian healthcare owes its facelift to changing consumer expectations.

Vishal Bali, CEO, Wockhardt says, “Indian consumers are being exposed to global healthcare standards and expect similar services here.” Consider this: today, a middle-level manager with a family of four spends between Rs 8,000-12,000 a year on healthcare, compared to Rs 2,000 in the late 1980s.

Corporate hospitals have not only raised the bar for healthcare in India but have also eased the pressure off government hospitals dealing with tertiary care. Waiting time for patients has dipped since those requiring immediate attention are promptly referred to a private hospital.

Praveen Chawla, COO, Fortis Hospital says, “The private sector is able to provide a much higher quality of healthcare.” Visit any corporate hospital today and the first thing you notice is the presence of people from low- to high-income groups under one roof, demanding and receiving the same services. As Dr Naresh Trehan, MD, Escorts Heart Institute and Research Centre says, “Healthcare is a business with a soul. So it is very important that corporates run it in a humane manner, laying their foundation on ethics and ethos associated with the healthcare industry.”

Famously referred to as five-star hospitals, private hospitals are now attempting to break away from this image and are reaching out to people from all walks of life through health insurance cover, competitive rates and even free treatment for some.

Mukesh Shivdasani, executive director, Max Healthcare and chief executive, NCR 1 explains, “Private hospitals are not as expensive as is perceived. Also, there are organisations that help the economically challenged in meeting hospital expenses.”

The growing demand for private healthcare and the awareness towards the sector has also encouraged insurance companies to push their health insurance policies, covering everything from doctor’s fees, room charges, diagnostic charges and medicine to pre- and post-hospitalisation expenditure.

Kartik Jain, marketing head for ICICI Lombard, believes that with the cost of healthcare going up and lifestyle diseases also witnessing a rise, there is a sudden need and demand for health insurance. Today, even corporates are sustaining employees by including health insurance as a benefit.

However, the number of people picking up a health insurance policy is insufficient. Health cover premiums account for less than one per cent of life insurance premiums. In fact, the health cover premium collections for 2004-05 were around Rs 1,800 crore.

One of the biggest benefits of corporatisation is the building of brand India as a medical tourism destination or, as Shivdasani puts it, a global healthcare destination. SAARC countries like Bangladesh, Afghanistan, Sri Lanka, Malaysia and Indonesia account for the most patients, with the US and UK following suit.

While patients from SAARC countries come in search of better healthcare options at competitive rates, for the US and UK it is primarily a matter of getting world-class healthcare at less than half the cost. However, the one factor that is pulling people into India is the quality of service in the healthcare industry.

“Hospitals are bending over backwards to make sure international patients feel comfortable,” says Chawla, “with services like airport pick-up and drop, a city tour, critical care and constant communication with the patient’s hotel.”

Take 56-year-old California resident Billy Schroeder, who was denied health insurance in the US due to high prostate-specific antigen and suspected cancer. The tests that confirmed he had prostate cancer cost him $7,000. Schroeder decided to head East for his treatment and came to Fortis

Hospital, Delhi. His complete surgery here cost him $10,000. “I think hospitals here are as good as, if not better than, any hospital in the US. The heartening thing is that the staff spends time with you and makes sure you are comfortable and satisfied.” A month after coming to India, Schroeder is now ready to head home...cured.

Beyond curing patients, corporate hospitals are transforming the lives of another set of people — doctors. The worth of doctors is now being realised not by the corporates alone but even by the doctors themselves.

Dr. Upendra Kaul, director and HoD, cardiology at Fortis Hospital, recalls, “I used to work at a government hospital and the experience was very different. In a private corporate set-up like this you don’t face bureaucratic hassles.”

The corporate set-ups have also given doctors access to resources like never before. Dr Ajaya Nand Jha, director of neuro-surgery at Max Super Speciality Hospital, has two high-end computers and one laptop in his office.

“I need these to keep records, track patients, communicate with other doctors and to keep myself updated with the latest happenings in the medical world,” he says. “In this competitive world, you need to keep running to stay in the same spot.”

The biggest benefit though has been in terms of salary and lifestyle change. Dr Arvind Taneja, director-paedriatrics at Max Hospital, admits being involved with a lot of administrative work at Max.

“I have been a consultant at many private and government hospitals but this has by far been my most advanced centre to date. We are working with technology that is enabling us to provide much more than just basic healthcare.”

An interesting trend among corporate hospitals is that of setting up super-speciality or multi-speciality hospitals vis-à-vis general hospitals. Speciality centres bring one medical department together under one roof.

So, you have a super speciality hospital focusing on neuroscience, orthopedics, obstetrics and gynecology, cardiac care and oncology. Speciality hospitals come into play once your illness has been diagnosed.

Thus, if you suffer from a neurological problem, instead of visiting a general hospital where you might be shunted from one department to another, you would ideally visit a hospital that specialises in neurological sciences and has all the necessary equipment and expertise in the field. Today these hospitals are also constantly investing large sums of money in the latest technology and machinery.

But like every other positive trend, the corporatisation of hospitals has its pitfalls. A major concern among doctors and patients alike is the filtration of expertise as you go down the ladder in doctor rankings.

Hospitals are selling their treatment services by hiring the best names from the medical field. But healthcare is not a one-man show. Whether the expertise is trickling down to the doctor’s juniors remains to be seen. The movement is still in its nascent stage and sustenance of service and standards over the next few years will be the decisive test.

Healthcare experts also feel the need for medical standardisation, accreditation and certification in the medical sector by the government, to maintain standards.

“We need standardisation to come into play in the country,” says Dr Dharminder Nagar, CEO, Paras Hospital. Agrees Trehan, “We are providing a service and must do so with decency and sensitivity towards the community. India needs more regulation in healthcare.”

Vishal Bali believes India needs to create drivers of affordability of healthcare for the average Indian. That, however, has not received sufficient attention in a rapidly growing economy.

In fact, the general belief is that private consultants are encouraged to ask for superfluous tests and even avoidable procedures so that the hospitals can recover the cost of the investments made in testing and other equipment.

Still, the availability of an alternative to government hospitals, and of quality care at reasonable cost, is changing the lives of tens of thousands. Vandana and her husband agree. “If you want good health, you have to pay for it, no matter what,” she says, as she steps into the hospital garden with her husband to sit in the sun.

THE WAY TO HEALING

Statistics

  • The Indian healthcare industry is now estimated to be a $17 billion (Rs 80,000 crore) industry
  • The total spend on the healthcare sector currently accounts for 6.1 per cent of the GDP, of which the government spend is 1.1 per cent
  • The annual growth rate of the industry is 13 per cent and is expected to continue at this rate for the next six years
  • Most healthcare users pay from their own pocket and prefer to use private services as compared to government services
  • India has only 43 doctors for every 10,000 people as compared to the 2,340 doctors per 10,000 people in the US
  • Hospitals in India run at an occupancy rate of 80-90 per cent
  • Major corporations like the Tatas, Apollo Group, Fortis, Max, Wockhardt, Piramal, Duncan, Ispat and Escorts have made significant investments in setting up state-of -the-art private hospitals in cities like Mumbai, New Delhi, Chennai and Hyderabad
  • India receives 1.5 lakh medical tourists every year. A CII-McKinsey report has projected that medical tourism could contribute Rs 5,000-10,000 crore as additional revenue for the tertiary care hospitals by 2012. This will account for 3-5 per cent of the total healthcare delivery market

Medical technology and services

Apollo Hospitals
  • # Introduced the revolutionary 64-Slice CT scanner that allows a full body scan in seven seconds
  • # Invested in the 3 Tesla MRI scanner that can show real time changes in body tissue and disease progression
  • # Pioneered in setting up the first modern secondary care, rural hospital, using telemedicine
  • # Has partnered with various organisations like ISRO, CDAC and the Government of Japan to increase the outreach of telemedicine
  • # Has entered into an agreement with John Hopkins Medicine International for collaboration in numerous clinical departments
  • # Entered into an agreement with Reliance Infocomm where Reliance WebWorlds will offer access to the Apollo Telemedicine Networking Foundation
  • # Set up new super speciality centres — Apollo Centre for Obesity Diabetes and Endocrinal Diseases, Apollo Pediatric Cardiology and Cardiac Surgery Unit and Apollo Centre for Advanced Pediatrics
  • # Plans underway to set up hospitals in Mauritius, Fiji, Ethiopia and Abu Dhabi

Max Hospitals
# Owns and operates six hospitals in Delhi and NCR. Plans to operate a total of nine hospitals in this region with an investment of Rs 700 crore
# Launched the Six Sigma Methodology for improving administrative processes to improve quality
# Acquired the Brain Suite, an intra operative MRI system. This is the first such installation in the Asia Pacific, and the third in the world
# Runs the Max TeleMed service, with special focus on Manipur, and plans to extend services to rural areas in the country

Fortis Hospitals
# Runs 11 hospitals across north India. Planning two more hospitals in the NCR with a total investment of Rs 550 crore
# Acquired the Escorts Group last year and holds 90 per cent intrest in it
# Planning a medical college in Gurgaon called Fortis Institute of Medical and Bio Sciences
# The Escorts Heart Institute and Research Centre has a tie-up with Air Deccan for its air ambulance service called Air Rescue One.
# Has an ongoing telemedicine network across north India.

Wockhardt Hospitals
# Are South Asia’s first Journal of Clinical Investigation accredited super speciality hospitals
# Have associations with Harvard Medical International, which gives them access to the best hospitals in the US for knowledge and research. Leader in medical tourism in India

MORE TO COME
# Escorts’ Dr Naresh Trehan’s Rs 1,200 crore project, Medicity, a centre for integrated medical sciences and holistic therapies in Gurgaon
# Apollo Tyres’ Artemis Hospital in Gurgaon
# Reliance Anil Dhirubhai Ambani Group’s multi-speciality hospital in Mumbai

VOICES

"The private sector has been actively involved in healthcare. What we are witnessing now is corporatisation" — Harpal Singh, chairman, Fortis Healthcare

"The access to high-end technology has become easier now and hospitals cannot afford to ignore this technology" — Vishal Bali, CEO, Wockhardt Hospitals

"Corporates should bring with them the highest degree of accountability. Privatisation of healthcare delivery by the right corporates is good for the country and the patients" — Analjit Singh, chairman, Max India
 

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I'm not sure if we have a thread of this nature but I certainly believe we need one. India has a gigantic population and its healthcare industry has to rapidly expand to improve the standard of living.

Personally I'm doubting private healthcare as the way to go. I think these services should be in the hands of an able government. But as an able government is far from reality privitization may just be the only option.

Here's a nice article I came across to start this thread:
It's good to have choices. I have worked in both government and private health care sectors in India. I like the Indian model better than the US (strictly private) or Canadian (strictly government) model. In India, if you can afford it and you want priority care, you can go to a private hospital. If not, you can go to a government hospital. So, I don't see anything wrong with the above article, as long as they don't do the unethical things that the HMOs do in the US.
 

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Discussion Starter · #3 ·
^^ But I don't think the Indian government is capable enough to enforce the hospital ethics and regulations required. What will probably happen is that the corporates will only care for their profit and there would be little or no regulation of the practices. Also, these private hospitals are further going to create a gap between the rich and the poor. Those who can afford proper care in private hospitals and those who cannot.
 

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^^ But I don't think the Indian government is capable enough to enforce the hospital ethics and regulations required. What will probably happen is that the corporates will only care for their profit and there would be little or no regulation of the practices. Also, these private hospitals are further going to create a gap between the rich and the poor. Those who can afford proper care in private hospitals and those who cannot.
Absolutely right.

Health care economics and ethics is complicated. We must start to see how health care should be delivered. For instance is health care aright or a privilege?

My personal view is that it is a social right.

But how should health care system be formed in India?
In Europe and Japan there is a mixture of state and private health care,where the state is the major contributor for delivering health care.

As the state structure looks now i am skeptical if the state can deliver good quality health care.

So what about the poor and those who don't have enough capital to spend on private health care?

my answer: let the Gov pay , no matter what the cost is.
 

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I think we have a huge shortage of doctors. Many more Medical Colleges need to be set up and people need to be trained as doctors. Same with nurisng. All other allied fields also need to be boosted. Health Infrastructure should also be created in suburban and rural areas. Not only will this improve the health scenario in the nation, it will contribute to economic growth.
Plus there has to be political momentum on this issue and implementation of laws and plans.

Private five star hospitals are fine. But how many people can afford them? Some of the private hospitals are basically money making machines.

What really is bothersome is that for decades we have had the sociialists-leftists in power and yet social areas are some of the most neglected! Goes to show the incompetent and sloganeering nature of our socialist-leftist elite - all slogans no impelmentation.

Only 128 doctors per lakh population in India

http://www.hindu.com/thehindu/holnus/001200612020312.htm

The doctor-population ratio in the country does not paint a very flattering picture of the status of medicare, with only 128 doctors available for every one lakh people.

The ratio works out to a dismal 1:781, Minister of State for Health and Family Welfare Panabaka Lakshmi said in a written reply in Rajya Sabha on Friday.

As per the statistics of the Medical Council of India, the allopathic doctor-population ratio at present works out to an even worse 1:1722.

There are more than six lakh practitioners of Indian Systems of Medicine and Homeopathy in the country, Lakshmi said.

There are 262 medical colleges with an annual intake of around 29,500 students, she said in response to a question on the steps being taken to improve the ratio.

"As existing in other professions, even in the medical sector, some doctors resort to migration abroad for improvement in one's prospects for professional, academic and financial considerations, which is a common feature in a number of countries," she said replying to a question on whether migration of doctors to foreign countries was one of the reasons.
 

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Discussion Starter · #7 ·
I think it's more important for the Indian health care system to focus more on the needs of its own population than to go to full lengths to attract medical tourists. There is no point in having a huge medical tourism industry when your own hospitals can't cater to the average population.

In terms of doctor shortage, with a huge population that will be a continuous problem. But in addition to training more doctors, they have to in some way keep the trained doctors in India. So many of them use Indian training and just emigrate from India. And the only way to keep these doctors in India is to have better hospitals and a proper system.
 

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The medical tourism is being led by private hospitals, and I suppose they can do whatever they want, as long as they are not breaking rules.

Providing primary healthcare to millions of children in such a huge country is a Herculean task, and despite the government's best efforts, it has always remained inadequate. Massive private involvement is the way to go.
 

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The medical tourism is being led by private hospitals, and I suppose they can do whatever they want, as long as they are not breaking rules.

Providing primary healthcare to millions of children in such a huge country is a Herculean task, and despite the government's best efforts, it has always remained inadequate. Massive private involvement is the way to go.
First of all, I think all the private hospitals vouching for international patients have to have their hospitals certified by healthy care agencies like HCA in US. Simply because big insurance companies who send their patients to India cannot go for Hospitals that do not match HCA (Hospital Corporation of America) standards. Sending patients to any other health care facility is an open invitation to costly law suits.

Secondly, this mushrooming of private hospitals provides excellent opportunity to expand medical education. If you notice, ALL medical colleges are located in a hospital. Government should liberalize the education and allow private hospitals to setup educational facilities and appoint a regulator on the line of TRAI in Telecom.

But with Mr. Arjun Reservation Singh in HRD, it is highly unlikely that will happen anytime soon.
 

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Discussion Starter · #10 ·
An interesting article...

Fixing India's healthcare system

S Sivakumar

India has made remarkable strides in increasing the life expectancy of its citizens. During the beginning of the 1930s, the average life expectancy of an Indian adult was only 32 years.

As of 2000,the average life expectancy stands at 64 years. Advances in medical science and improvements in sanitation have reduced the spread of infectious diseases, better medical facilities, preventive measures using vaccines against diseases such as polio, measles and awareness have contributed to the rise in life expectancy.

This article analyses the state of healthcare in India, indicates some of the deep-rooted structural problems, and highlights possible solutions to address the problem.

J K Arrow, the Nobel Prize winning economist laid the foundation of health economics. His major contributions to the field are medical economics of social choice, social investment criteria, market failure in healthcare, behavioural aspects of healthcare under uncertainty and optimal insurance.

The principles are relevant for India's healthcare research and policymaking. The growth in per capita income, increasing urbanisation, availability of modern biomedical technology, education and overall awareness indicate that demand for healthcare is bound to increase in the country.

There is a two-way causality between health and economic development. Countries, which are economically well developed, tend to invest more on healthcare.

Greater investment in healthcare also leads to longer life expectancy, less morbidity and increasing work productivity that results in economic progress.

Over the last two decades, life expectancy at birth in India has increased by approximately double the increase in life expectancy in middle income and high-income countries.

However, the average Indian life expectancy is 15 years less than that of a citizen of a high-income country. Notice the low levels of public expenditures on health in India compared to middle income and high-income countries.

The ratio of India's purchasing power parity-adjusted per capita income to that of middle-income countries is 52 per cent and that of high-income countries is 10.6 per cent. The ratio of India's purchasing power parity-adjusted health expenditure per capita is 35 per cent of middle-income countries and 3.6 per cent of rich countries.

Even allowing for some wasteful expenditure in developed countries, we are certainly under investing in health. Notice the low levels of public expenditures on health in India compared to middle income and high-income countries.

The number of physicians per 1000 people has remained unchanged in India over the last twenty years. Another unique feature in the country is the usage of public health services by the bottom 20 per cent of the population (classified by income), which is only marginally higher than the top 20 per cent of the population.

Hence, there is urgent need to rejuvenate the public healthcare system to ensure that the poor get access to essential medical services.

Though the budget resources are scarce, there is certainly a need to double the public expenditure on health, given the long-term benefits. The emphasis should be on prevention and making essential public health services available to the poor.

About 88 per cent of the pregnant women are anaemic. India is unfortunately leading the world in this risk factor. The surprising issue is that this is not related to income distribution.

Other aspects such as low birth weight babies and child malnutrition are close to the poverty line numbers. While deadly diseases such as Tuberculosis and HIV are receiving public attention, the long-term consequences of in utero problems have been neglected.

Rober Fogel, the Nobel prize winning economist emphasises that "It may well be that a very large increase in expenditures on ante-natal care and paediatric care in infancy and early childhood is the most effective way to improve health over the entire life cycle, by delaying the onset of chronic diseases, alleviating their severity if they occur, and increasing longevity."

In a study published in The Lancet 1996, which evaluated 517 men and women born between 1934 to 1954 in a mission hospital in Mysore, 9 per cent of the men and 11 per cent of the women had coronary heart disease.

Low birth weight, short birth length and small head circumference at birth were associated with the prevalence of this disease.

The highest prevalence of the disease (20 per cent) was in people who weighed 5.5 lbs (2.5 kg) or less at birth and whose mothers weighed less than 100 lbs (45 kg) during pregnancy. In India, coronary heart disease is pitted to become the most common cause of death within 15 years.

Some of the key problems are low public spending on health, lack of emphasis on prevention, enforcing standards of medical care rendered by hospitals and private health practitioners, insurance to provide financial protection from catastrophic events, more research, awareness and communication and greater public involvement in understanding health issues. It is of paramount importance to increase public spending on health.

Given that even the poor are not using public health services, it is time to revamp it to offer basic essential services of good quality to all and charge in a graded fashion for specialised services.

A significant portion of the spending must be targeted toward prevention by subsidising and making available nutritional supplements for pregnant women.

Substantial efforts must be directed toward acquisition of 'womb to tomb' data on health and ill health. Such research efforts can yield insights into the risk factors that lead to chronic diseases.

The importance of ante-natal healthcare must be disseminated widely in India. The Indian Council of Medical Research has already done some work in this area.

More needs to be done. One of the creative ways is to harness college students to spend at least 100 hours as part of their curriculum to create awareness of health in rural and remote areas.

Presently doctors conduct camps in rural areas for testing, administering antibiotics etc. By creating awareness, you can lower the cost of dealing with chronic conditions later on in life and enhance the quality of life.

The private sector can create incentives for students who undertake such activities by explicitly including such community service as a factor in their recruitment decisions.

The private sector must also fulfil its social responsibility by committing some resources to non-governmental organisations and holding them accountable for results.

India does not have a functional western model to follow in healthcare. The non-price rationing by queuing in Canada/ Britain and the price-based rationing in the US are not functioning effectively. India has its own system with private healthcare practitioners, who are largely unregulated, playing a significant role in meeting the healthcare needs of people.

More disclosure on the part of the private clinics and hospitals must be made mandatory so that the public can assess the quality of medical care and get some understanding of the track record of practitioners and hospitals.

Research has shown substantial medical expenditure occurs during the last two years of a person's life. A broad based hospitalisation catastrophic insurance must be offered to protect individuals in their old age.
The benefits clearly defined and properly enforced can minimise fraud and delays in these programmes. Last but not the least, more collaboration is needed between doctors and economists to jointly pursue research and make health economics a robust discipline for specialisation. A healthy India is certainly a precondition for a wealthy India.
 

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Discussion Starter · #11 ·
Apollo Hospital New Delhi - Designed by Hafeez Contractor







 

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Elbit, Ambuja Realty to build hospital chain in India

Israel-based Elbit Medical Imaging Ltd. said it signed a joint venture with India's Ambuja Realty Group to develop and operate a chain of multi-specialty tertiary hospitals in India.

The company said the first hospital in the chain will be a 1000-bed centre in Kolkata and the capital investment in the project will be about 10 billion rupees (about $230 million) over a period of several years.

http://today.reuters.com/news/artic...TURE-AMBUJAREALTY-URGENT.XML&rpc=66&type=qcna
 

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Corporate hospital sector witnesses healthy growth

The corporate hospital sector of the country is all set to take away a significant share of the tertiary healthcare service business from individual private healthcare providers by 2010.

All major players, doing brisk business, have lined up plans for green field projects and acquisitions capable of at least doubling their capacities within two years.

Existing corporate like Apollo, Fortis, Wockhardt and Max have all announced plans for setting up new healthcare facilities. Corporate groups like Apollo Tyres and Paras are among the new entrants in the healthcare business.

The move is triggered by the growth in the GDP, emergence of health insurance and expected growth in the medical tourism.

Says Vishal Bali, CEO, Wockhardt Hospitals “The corporate healthcare segment is to replicate the success of Indian IT sector. Healthcare space is getting more and more organised. Ten years from now, 30 - 40% of tertiary healthcare delivery could come from corporate sector.”

Wockhardt which had a bed strength of 650 two years ago, currently has 10 hospitals with 1500 beds across five states. Two 250 bedded hospitals are coming up in Calcutta and Delhi. The company intends to reach out to second tier cities too in future.

Meanwhile, Max Healthcare Institute Limited, a major player in the National Capital Region of Delhi saw its revenue from all six hospitals grow 195 per cent during 2005-06.

The company, that will complete its first phase of expansion with the completion of its 100 bedded hospital in Gurgaon next year is planning to go beyond NCR as its next growth phase.

The consolidated turnover of Apollo Hospitals Group, leading healthcare chain of the country also showed a steady growth during the last few years. Apollo also added 255 beds to its combined bed strength during H1 2006.

Paras Healthcare, the new entrant into the hospital business, plans to invest about Rs 650 crore in next two years to set up five specialty hospitals in NCR region. The first project of the group, a 250 bedded speciality hospital focusing on neuro-surgery, trauma, orthopedics, and mother & child, is already completed.

“The second phase of our expansion involves the setting up of three green field hospitals and two acquisitions in NCR within two years. Our green field projects will have a bed size of 250 each and the acquisitions will be of small facilities with 60 - 70 bed strength”, Dr Dharmender Nagar, Managing Director, Paras Hospitals said.

The report of the National Commission on Macroeconomics and Health had estimated the size of private healthcare sector in India to be worth Rs 69,000 crore and projected that size to double to Rs 156,000 crore by 2012,besides an additional Rs 39,000 crore if health insurance picks up. With the current pace, the corporate segment in the private medical service sector is likely to absorb a good share of this business.
 

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Hmmm!
It's really interesting that forumers have started to discuss about this topic. Let me get some points clear.
1. Are we talking here about buildings which provide physical health care?
2. Are we seeing 'Health' here as an industry?
3. Are we talking about 'Health' as a basic/fundamental right?
It's incredibly complex if we talk about 'Health' as basic concept or as defined holistically. To talk about 'medical tourism' in India, without looking in to the shabby public health service available to millions of poor is an unethical, hypocrtic and extremely complacent way of seeing improvement of health care in India. What we have seen is vertical development in tertiary health care technology catering to medical illnesses, rather than 'True health'.
There is an issue of industry here, of course.
We also need to see it's relation with primary education and population explosion.
However, few signs of optimism can be smelt. I am just putting them randomly:
1. Prime minister's NRHM (National Rural Health Mission).[http://mohfw.nic.in/nrhm.html]
2. Establishment of several public health institutes collborating with
International institutes like John Hopkin's Bloomberg school of public health
We can also try and replicate good public health service seen in some states, like Kerala (through different public health indicators).
Finally on my recent trip to a small village in Assam, I witnessed a community hospital (also the FRU for the region, FRU being First Referral Unit) doing extremely well ( as told to me by a staff). It even has been rated the best in Asia in it's category on several performance measures. I, of course could not verify it personally. I took two photographs of the same. Here, one of them:


Have you guys explored the NEIGRIMS?
Find out more in [http://neigrihms.gov.in/]
One image of the institute:

This is courtsey: http://www.flickr.com/photos/[email protected]/

Any comments?
:eek:hno:
 

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Another thing, if somebody talks about model of health care in India, I would very much prefer a two-tiered system. It would draw the best example and best practices of private institutes (e.g. Kaiser Permanente) (http://www.kaiserpermanente.org/) and improved goverment aided equitable public health infrastructure. How these two will marry is a different problem to solve again.
THIS MUST BE A FANTASY ON MY PART
 

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Hmmm!
It's really interesting that forumers have started to discuss about this topic. Let me get some points clear.
1. Are we talking here about buildings which provide physical health care?
2. Are we seeing 'Health' here as an industry?
3. Are we talking about 'Health' as a basic/fundamental right?
It's incredibly complex if we talk about 'Health' as basic concept or as defined holistically. To talk about 'medical tourism' in India, without looking in to the shabby public health service available to millions of poor is an unethical, hypocrtic and extremely complacent way of seeing improvement of health care in India.

Any comments?
:eek:hno:
Well the thread has just started. What course it takes depends on what forumers discuss.

I don't see anything wrong with highlighting Medical Tourism. It's part of the health "industry". Similarly someone wants to highlight achievements and failures of the public health "services" it is fine.
A new thread always takes some time to evolve.
 

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Indian Soul has good points in his post, and from I understand, medical tourism is but once facet of this whole thread.

Ideally, I would like to discuss our domestic healthcare infrastructure more, and with the government supposedly more open to private role in that, we will get to see many more private sector hospitals coming up in all parts of the country which will also cater to public healthcare.

While I understand many of these hospitals will mostly cater to the more well off, but like you said, hopefully we will get to see an excellent system of government aided and guided public health infra lead by the private sector.
 

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Morpheus
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Thanks Kronik. If only I am allowed to be sceptical, please go through this serious stuff...:?

(From http://phm-india.org/issues/nrhm/ruralhealthpolitics.html)

The Politics of Rural Health in India
- Debabar Banerji, Professor Emeritus, Centre of Social Medicine and Community Health, JNU




The setting up of the National Rural Health Mission is yet another political move by the present government of India to make yet another promise to the long suffering rural population to improve their health status. As has happened so often in the past, it is based on questionable premises. It adopts a simplistic approach to a highly complex problem. The Union Ministry of Health and Family Welfare and its advisors, either because of ignorance or otherwise, have doggedly refused to learn from the many experiences of the past, both in terms of the efforts to earlier somewhat sincere efforts to develop endogenous mechanisms to offer access to health services as well as from the devastative impact on the painstakingly built rural health services of the imposition of prefabricated, ill-conceived, ill-formulated, techno-centric vertical programmes on the people of India. The also ignore some of the basic postulates of public health practice in a country like India. That did not substantiate the bases of some of their substantive contentions with scientific data obtained from health systems research reveals that they are not serious about their promise to rural population. This is yet another instance of what Romesh Thaper had called `Baba Log playing Government Government'.

Political Dimensions of the National Rural Health Mission
In the formation of the National Rural Health Mission (NRHM) (1) we hear echoes of what Rudolf Virchow (2) had said in that fateful year of 1848 - that health is politics and politics is health, as if people matter. Despite making numerous solemn promises to improve the situation since India gained Independence, the state of the rural health services to this day is extremely unsatisfactory. This is rooted in the politics of heath and health services of the past. However, to garner the rural votes, during the 2004 elections, some political parties expressed `deep concern' over these shortcomings and made yet one more promise to rectify the conditions. After the elections, they brought together some other parties to form of the United Progressive Alliance (UPA), which was able to form the government at the Centre. Improvement of the rural health services was included as a part of the Common Minimum Programme (CMP) agreed to by the UPA.



The obviously limited political commitment to improving rural health services has confined the NRHM mostly to some superficial issues that have come in the way of development of the rural health services. For instance, while the UPA has regretted that India has the unenviable distinction of being among the lower five countries of the world in terms of the percentage of the GDP allotted to the health services (0.9%) (1), it has not analysed the politics of the of the process of the steady decline of the percentage over the years. The same considerations have led to their ignoring the fact that while the public sector heath expenditure accounts for some 70-90 per cent of the total health service expenditure in rich European countries, it hovers around 20 per cent in India. The CMP contains promise to increase the expenditure to `2-3% of the GDP' in the five years of the rule by the PHA. The budgetary allocations for the first two years do not appear very promising (3). Furthermore, because of its very apparently limited purpose, the NRHM has got to be ahistorical in its approach. It has to adopt a simplistic approach to a highly complex problem. It provides little scientific evidence, based on health systems research, to substantiate its recommendations. Even a cursory look at the history of public health in the country will expose many serious flaws in the formulation of the NRHM. These considerations will be taken up in some detail after a brief review of the trends in health service developments in the past and the politics which has shaped them.

Early Phases of Growth and Development of Health Services
The politics of health and health services was qualitatively very different and much more powerful during the freedom movement. This was summed up by the National Health (Sokhey) Sub-Committee of the National Planning Committee of the Indian National Congress (4) in 1940. What it has called `the cornerstone of the scheme of their recommendations' was a Community Health Worker for every 1000 of village population. This worker is trained in practical community and personal hygiene, first aid and simple medical treatment with stress on social aspects and implications of medical and public health work. It also recommended that, `Practitioners of ayurveda and unani systems were to be drawn into the state health systems, after giving them further scientific training when necessary.'

The report of the Bhore Committee (5), submitted in 1946, is to this day regarded as an authoritative document, not only because of its distinguished authorship but because many of its proposals and recommendations continue to be valid even today. It was guided by such lofty principles as `nobody should be denied access to health services for his inability to pay' and that the focus should be on rural areas, with emphasis on preventive measures and training of what it called `social physicians'.

After Independence, the political soil was not adequate to nurture the seeds of hope that took shape during the freedom struggle. However, during the early years the new rulers were impelled to carry over some of the democratic processes in making decisions concerning health. Taken as a whole, these decisions gave a perspective to public health principles and practices in the country, which was markedly different from the ones preached in the conventional schools of public health in Western countries or elsewhere (6). Despite considerable difficulties and shortcomings, India could develop an endogenous, alternative body of knowledge that was more suited to the social, cultural, economic and epidemiological conditions prevailing in the country. This led to the emergence of an alternative approach to education, training, practice and research in public health (7). Mention of highlights of some of the major decisions are being made to elaborate on the outcome of the pro-poor ambience which lasted during the early years of Independence.



Following the acceptance of the report of the Bhore Committee by rulers of the newly independent country, a start was made in 1952 to set up Primary Health Centres (8) to provide integrated promotive, preventive, curative and rehabilitative services to entire rural populations, as an integral component of a wider Community Development Programme (9) - it sought to be an integrated health services approach as a component of intersectoral action, as was envisaged much later in the Alma Ata Declaration on Primary Health Care (10).



Departments of social and preventive medicine in medical colleges were upgraded to give social orientation to medical education (11), (12)),(13). Apart from the already existing highly rated institutions like the All India Institute of Hygiene and Public Health (14) and the Malaria Institute of India (15), institutes such as the National Institute of Communicable Diseases (16), National Institute of Health Administration and Education (NIHAE) (17) and the National Tuberculosis Institute (NTI) (18) were established in the 1960s, to provide support to education, training and research to the budding health service system of the country.



During 1961-64, interdisciplinary research work done at NTI received worldwide attention (19). Perhaps the most remarkable feature of its work was to give primacy to people (20). Imparting sociological dimensions to epidemiological issues (21), developing people oriented technologies and formulation and use of operational research approach in public health (22),(23), can be cited as instances of some other features of the National Tuberculosis Programme (NTP) developed at NTI . NTP was designed to sink or sail with the general health services (20).



The convulsive political changes that took place in the 1970s impelled the Central Government to implement the vision of the Sokhey Committee of having one Community Health Worker for every 1000 people to entrust "People's health on people's hands"(24). At least on paper, India had developed a network of health services, which compared favourably with any country in the world with similar socio-economic situation. There was a Community Health Volunteer/Volunteer and a Trained Birth Attendant for every 1000 population, a sub-centre with a male and a female multipurpose health worker for 5000 people, a primary health centre for every 30,000 people and a community health centre for 100,000 persons, with referral and supervisory and supportive echelons which went right up to the national level. As providing health services to the population was considered a responsibility of the government, these services were offered free of charge.

India had thus came quite close to the Alma Ata Declaration on Primary Health Care made by all the countries of the world in 1978 (10). The Declaration included: commitment of governments to consider health as a fundamental right; giving primacy to expressed health needs of people; community self-reliance and community involvement; intersectoral action in health; integration of health services; coverage of the entire population; choice of appropriate technology; effective use of traditional systems of medicine; and use of only essential drugs.

Phases of All Round Decline in Organisation and Management
Not unexpectedly, there were huge gaps between the policy commitments and their implementation. Significantly, as late as in 1982, the government party, which had been ruling the country during the past 35 years, made a major move in the politics of health by coming up very sharply against the heath work done in the country during that period. In the document on its National Health Policy of 1982 (25), it had described the health services at that time `has been largely engendered by the almost wholesale adoption of the health manpower development policies and establishment of curative centres based on western models, which are inappropriate and irrelevant to the real needs of the people and the socio-economic conditions obtaining in the country. The hospital-based disease and cure oriented approach towards the establishment of medical services has provided benefits to the upper crusts of the society, especially those living in the urban areas.' It took another 20 years for the government of India to confess in the 2002 edition of its National Health Policy (26) that the promise made in the 1982 were `too ambitious' (!!) and that it needed toning down. The NRHM (1) is the latest phase in the making promises to the long suffering deprived sections of the people of the country.



However, the reasonably correct public health commitments made at the initial phases could have been used as a springboard for more effective implementation of the philosophy of Primary Health Care in India. This did not happen. Significant shifts in the power relations between the rich and the poor, both within the country and internationally, came in the way. Even the limited hopes aroused during the early years after Independence were belied.



The seeds of a retreat from the promising start were sown as early as in 1967 (27). A virtual mass hysteria was worked up by the ruling elite and their mentors from foreign countries about the perils of population explosion. A common refrain those days was to exclaim that `the fruits of development are being eaten away by the exponential growth of population'. It was obviously inconvenient for the proponents of population control to ask the simple question: who had been eating away the so-called fruits of development during the earlier two decades? It was inevitable under the highly polarised power relations that the only way to control population growth among deprived sections was to use force. To get this hatchet work done, the politicians preferred the bureaucrats, who still carried the colonial tradition of imposing the will of their masters on the people. They also lacked adequate technical competence which could embarrass their masters by asking inconvenient questions. Another `qualification' of bureaucrats is that they are ahistorical - they have short memories, as they frequently hop from one ministry to another. The politicians of all hues, bureaucrats and foreign agencies formed a formidable nexus - a powerful syndicate



The Union ministry of health was crudely `partitioned' into departments of health and family planning. Family planning was accorded overriding priority by the government (27). People became the `targets' of their own government (28),(29). Most of the political parties within or outside the legislatures, the intellectuals and social activists were mute spectators, if not active promoters, of this gross violation of human rights of the masses of people for three decades (30). However, as described in detail elsewhere (30), despite almost astronomical allocation of funds to family planning, as compared to other health programmes, the population of the country shot up from 351 millions in 1951 to over a billion in 2001 - `greater the allocation, the greater is the decennial rise in population growth!' In addition, preoccupation with family planning led to gross neglect of the health services, which were so painstakingly built over the first two decades after Independence.



Then, there were the far-reaching consequences of the responses of the rich countries to the declaration of self-reliance by the poor people of the world at Alma Ata in 1978 (31). Their response was swift and sharp. Knowingly or otherwise, they betrayed profound lack of understanding of the basic philosophy of the Alma Ata Declaration of entrusting "People's health in people's hands", by contending that most of the developing countries were too poor to undertake what they called `comprehensive primary health care' (32). Instead, in 1979, these descendents of the European Enlightenment virtually fabricated, without producing any scientific evidence, an alternative approach of limiting action to dealing with a few diseases at a time which they claimed to be cost-effective and which can be managed by such countries - and it received a proud place in the New England Journal of Medicineas a `profound' piece of research (32),(33),(34) (35).



This alternative was called the approach of Selective Primary Health Care (SPHC), which is the very antithesis of the concept of primary health care (PHC) (36),(37),(38) Under the substantially changed political equations between and within countries, the political leaderships of poor countries were `persuaded' by rich countries to give up some of the key elements of PHC in their health services in favour of SPHC.



The rich countries mobilised organisations such as the WHO, UNICEF and the World Bank to promote their agenda of SPHC (35),(39). This led to opening up of a virtual barrage of what the international agencies called International Initiatives (39),(40),(41). These `vertical' or `categorical' programmes were ill-conceived, prefabricated, technocentric programmes, which were imposed on the poor countries of the world. Worse still, despite massive investment running into billions of US dollars in these vertical programmes on a global scale, they have fallen far short of the forecasts made at the time of their launching (42).



Government of India, in its National Health Policy 2002 document (26) makes a forthright `confession' of the degree to which its health service system suffered for agreeing to the donor driven vertical programmes (including immunization, Tuberculosis and AIDS). It now says: `Over the last decade or so, the Government has relied upon a `vertical' implementational (sic) structure for the major disease control programmes. Through this, the system has been able to make a substantial dent in reducing the burden of specific diseases. However, such an organisational structure, which requires independent manpower for each disease programme, is extremely expensive and difficult to sustain. Over a long time range, `vertical' structures may only be affordable for those diseases which offer a reasonable possibility of elimination or eradication in a foreseeable time frame"...



It goes on to state :"It is a widespread perception that over the last decade and a half, the rural health staff has become a vertical structure exclusively for the implementation of the family welfare activities. As a result where there is no separate vertical structure, there is no identifiable service delivery system at all. The Policy will address this distortion in the public health system".



These had been an awe-inspiring demonstration of power of the rich to impose their will on the poor. As late as in 2001, WHO's much publicised Commission on Macroeconomic of Health (43:68), which, incidentally, included the eminent Indian economist-politician, Manmohan Singh, had strongly advocated adoption of vertical programmes.



In addition to the imposition of the International Initiatives, the International Monitory Fund had imposed conditionalities in return for extending loans to bail out the government of India from the financial morass of the early 1990s. Their Structural Adjustment Programme (SAP) enabled the IMF entry into most vital elements of the governance of the country in the form of influencing budgetary allocations in the country. Dutifully submitting to their dictates, the then Union finance minister Manmohan Singh inflicted a 20 per cent cut in the health budget of 1992-93, without taking into account the inflation (44),(45). The impact of the SAP on the state health budgets was even more devastating. The decimation of the state funded health service system enormously expanded the space for private initiative. Indeed, the government extended assistance to the private sector in the form of various types of duty exemptions and incentives. The governments were also made to undertake a most unimaginative regime of `cost recovery' from the pitiably meagre allocations made for the government funded health services (44),(45),(46). The breakdown of the public health system rapidly expanded the `market' for the private sector.



The government's moves towards globalization further extentuated this trend of commodification of the medical services. There has been a mushrooming growth of numerous unregulated profiteering private hospitals, nursing homes, diagnostic centres and other ancillaries of the medical industry. With unabashed political support, unregulated institutions for education of physicians and other health personnel such as dentists, nurses, homeopaths and vaids rapidly expanded in the private sector as they became a lucrative field for making profits at the expense of the suffering of the people..



All these trends point to what Ivan Illich (47) had long ago mentioned as medicalisation of life. Producing dependence - almost addiction - to medicine and generation of iatrogenesis of various kinds, were mentioned by him as maladies of the market driven `modern' medicine. Systemisation of medicine, when healers become a cog of the wider `system' and its even more awesome manifestation in the form of a still bigger conglomerates -conglamoratisation - have been the more advanced manifestation of this malignant trend in the `developed' countries (48). The vast proportion of suffering people of the world, who have lost their endogenously developed coping capacity and who are unable to pay the exorbitant rates charged by the private sector institutions, were left in the lurch - it is a case of Marie Antoinette Syndrome - no free lunch for the poor! Illich's prescription (47) for this dilemma is demystification of medicine and increasing coping capacity of the people to deal with their health problems, as also visualized by Gandhi (49), John Grant (50), the Sokhey Committee (4) and Borremans (51).



Conventional public health organisations have virtually ceased to perform the function of preventive work. Even the work of epidemic control has sharply deteriorated. Information system to identify outbreaks of epidemics and emergency action to control them, as was done even in the colonial days, has long ceased to exist. Even the few of the outbreaks that get reported in news media elicit tepid response from the authorities, including pivotal investigative agencies. People, including those who pretend to take their side, meekly submit to outbreaks of several `epidemics of epidemics'.



The imposition of the TRIPS regime by the World Trade Organization has led to steep escalation of prices of drugs.

Present State of the Health Services
The foregoing analyses of different phases and facets of the health services of the country make it possible to get an idea of the state of the health services. It will be sufficient here to refer only to a few of major studies.



An Independent Commission on Health in India (52) (ICHI), set up by the Voluntary Health Association of India, which submitted its report to Prime Minister Vajpayee in 1997, had pointed out that the health services `are in an advanced stage of decay'. Equally expectedly, this evoked little action from the head of the government or from the concerned minister. Documents from the Planning Commission also paint an equally gloomy picture (53),(54). A study of a national sample of community health centres (CHC) (55) by the Programme Evaluation Organisation (PEO) of the Planning Commission has revealed that virtually none of them is working at its optimal level. The 1992 and 1998 Rounds of the Family Health Survey (56), (57) revealed that India is among the countries having the highest rates of maternal mortality. The survey conducted by the National Council of Applied Economic Research (58) revealed that, among the poor, expenditure incurred to meet the medical needs is the second most important cause of rural indebtedness.



A newspaper report (the Pioneer, New Dehli, April 23, 2005) quotes the Programme Iplementation Division of the government of India as saying that with the exception of the (small) States of Nagaland and Harayana, there has been `zero per cent' growth in the setting up of Primary Health Centres; the target was 193. The performance in terms of setting up Community Health Centres (CHC) is equally pathetic. As against the countrywide target of 103, merely 11 CHCs were set up during April 2004 and January 2005. The Mission Document (1) too draws a bleak picture - hospitalized Indians, on an average, spend 58% of their total annual income; over 40% of hospitalised Indians borrow heavily or sell their assets to cover expenses; over 25% of hospitalised Indians fall below poverty line because of hospital expenses.

Evidence Base of the of the Approach of the Mission
The approach adopted by the Mission provides a telling evidence of the lack of competence of the political and bureaucratic leadership of the Ministry of Health and Family Welfare (MOHFW) and its advisors to develop thinking to rectify what the ICHI had rightly termed in 1997 as an `advanced stage of decay of the health services system, particularly the rural health service system of the country'. As mentioned earlier, the Mission has adopted a simplistic approach to a highly complex problem. Instead of considering the health services as a complex, interacting system, they have selected a few catchy slogans such as `Accredited Social Health Activists' (ASHA), Panchayat Health Committees, Rogi Kalyan Samities, health planning starting at the village and district levels, setting up rural health missions at the district, state and national levels, and so on. It brings to mind what the late Romesh Thaper had mentioned in the context of the Emergency of 1975-77, as `Baba Log playing government government'.



There are three fundamental infirmities in the Mission Document which seriously erode its credibility for dealing with the daunting task of improving the health situation in rural populations, particularly in the backward regions:

The MOHFW seems to be doggedly refusing to learn from the past experiences. The most conspicuous among them was the experience of the large scale employment one Community Health Volunteer (CHV) for every 1000 people, along with setting up of a trained dai in every village, by the Janata Party government, which came to power in the wake of withdrawal of the Emergency. The CHV Scheme, which at one stage had more than 450,000 workers, could not be sustained because of the nature of the power structure in villages. If anything, the class-caste equation has deteriorated much further following the `mandalisation' of the population. The MOHFW did not learn any lesson from this experience while formulating the centrepiece of the recommendations of the Mission - that of having ASHAs in every village of the country. One of the advisors involved in formulating the NRHM (1) got so much carried away by their `re-invention of the wheel' that he visualized `These women should emerge as the missionaries dedicated to advancing health in India. Money, medicines and medical facilities will be meaningless without these missionaries'. If he had analysed the causes of failure of the CHV Scheme, he would have realised that he was unwittingly writing the obituary of the NRHM! One explanation for such a major flaw of thinking in the formulation of the NRHM could be that the bureaucrats of the MOHFW and their political masters had never been very serious about the plight of the deprived sections of the population. Otherwise, how can one explain the `advanced stage of decay' of the health services six decades after Independence?



The MOHFW and its advisors must have suffered from massive blind spots about well established principles of public health practice when they developed their vision of the rural health services. For instance, developing facilities for education and training of Managerial Physicians, who have the epidemiological, managerial, social and political competence to provide leadership in the administration of the health services in the country, ought to have found a key place in the in the Mission Document. It was perhaps necessary for the MOHFW officials to develop the blind spots, because, otherwise it would not have been possible to justify giving dominant positions to unqualified, ministry hopping bureaucrats in the MOHFW, or, for that matter, having physicians with no public health qualification or even experience to occupy key positions in the health administration - sorts of square pegs in round holes. Other key issues such as the cadre structure at the State and Central levels, epidemiological approach to solving community health problems, social orientation of education and training of different categories of health workers, and line and staff alignments in the drawing up the organizational structure, have been kept out of the range of vision of the Mission. Political leaders have also looked the other way, as these blind spots conveniently fall within the purview of their politics of health and health services



The central task for the NRHM was to produce data which would enable the MOHFW to devise the mechanism(s) to make most effective use of the resources -- in terms of the funds, technology, organization management, etc -- within the constraints of given social, cultural, economic, epidemiological and other such conditions: that is, it was required to find ways of optimizing use of resources under given conditions However, NRHM has produced little supportive data for carrying out its elaborate Plan of Action, which encompass a number of key components -- technical support mechanisms, including conceptualization of a Programme Management Support Centre and Health Trust of India, role of the Central and State government machinery, Panchyati Raj Institutions, NGOs and paying attention to special problems to the North-Eastern State and Mainstreaming AYUSH (Ayurveda, Yoga, Unani, Siddha and Homeopathy). Thus, it ought to have been a classical problem of systems analysis and operational research (22),(24). The NRHM has failed to substantiate their contentions with appropriate research data derived from health systems reaserch, using such methods: there is no scientific evidence base to justify the proposals made by them will lead to optimization of the use the resources. This is a grave infirmity in the Mission Document. In the absence of supportive scientific evidence, it almost amounts to practice of public health quackery. Furthermore, the system conceived by them excludes such vital elements as health human resource development, cadre structure at the Central and State levels and organisations for conducting health systems research at various levels. The timid mention of `Action research' goes to show their lack of understanding of the research needs As issues such as nutrition, access to adequate amounts of protected water and proper environmental sanitation has critical bearing on the health status of the rural populations, these also ought to have formed key variables in the analysis of the rural health system. Confining analysis to a truncated portion of the rural health system and that too in the absence of a minimal evidence base, cuts at the very root of the approach of the Mission. It will turn out to be a fatal lapse.

The NRHM, should, however, be commended for attempting to make a `bottom-up' approach to development. It has also gone beyond the somewhat halting steps spelled out in the National Health Policy of 2002 by categorically stating that the `National Disease Control Programmes for Malaria, T.B.(sic), Kala Azar, Filaria, Blindness and Iodine Deficiency , and Integrated Disease Surveillance Programme shall be integrated under the Mission for improved programme delivery'. The massive Programme under Family Welfare also falls in this category. Not unexpectedly, however, the actual delivery of the services under the National Disease Control Programmes retain their `essential verticality', as envisaged in the original documents of these vertical programmes. These find mention in the Annexures1-5 of the draft guidelines given in the Indian Public Health Standards (IPHS) for Community Health Centres (CHC) (62), prepared by the NRHM. Had it not been so, echoes of the integrated National Programmes could have been heard all along the line, down to the work specifications of the ASHA.



It is worth noting that the Task Group-III of the NRHM, which was assigned the task of preparing document on IPHS (59), after discussions with the RHM authorities, stated that `the paper was scaled down to discuss the requirements for the minimal functional grading of the CHCs with scope for further upgradation'. Essentially, the `minimal functional grading' was the same as those worked out when the CHC scheme was launched long ago. Furthermore, while the Mission had identified 18 States of the country, `which have weak public health indicators and/or weak infrastructure', namely, Arunachal Pradesh, Assam, Bihar, Chhatisgarh, Himachal Pradesh, Jharkhand, Jammu and Kashmir, Manipur, Mizoram, Meghalaya, Madhya Pradesh, Nagaland, Orrisa, Rajasthan, Sikkim, Tripura, Uttaranchal and Uttar Pradesh, this may well turn out to be a Quixotic assignment for the Mission personnel when it is realised (as was demonstrated in PEO Report on CHC and the recent report on Programme Implementation, 2004-5) that very few of the CHCs in the remaining `non-weak' States of the country come anywhere near fulfilling the `minimal grades' set by the IPHS of the task Group-III. Under such conditions, visions of such formidable tasks as `provision of 24-hour service at least in 50% of the PHCs', `ensuring conformation to IPHS at CHCs', `public-private partnership', `reorientating health/medical education to support rural health issues' and `pooling of medical care expenses', come very dangerously close to mere wishful thinking.



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Hi,
Here are some pictures of the National Drug Dependence Treatment Centre at Kamla Nehru Nagar, CGO Complex, Ghaziabad. It's a part of the AIIMS, New Delhi. It is the national centre for treatment and research on addictive disorders. It does not get publicity like Apollo, Fortis as there is no industry issue here. But it's a part of the health care infrastructure of the country. It featured in Lancet at some point. Enjoy! The photos were taken in 2004- a bit old, no doubt.


The panoramic view from front



Another view, not a panoramic one, taken from roof of the adjacent hostel



First floor



Attic and corridor in first floor
 

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Space Hospitals lines up Rs 25 cr for expansion

Chennai-based telemedicine service provider, Space Hospitals Ltd, is expanding its services by setting up 500 satellite medical centres, 800 telemedicine centres, and 40 more hospitals in the next one year across India.

By the end March 2007, the company plans to establish 126 telemedicine centres, 38 satellite medical centres and 10 regional associate hospitals.

In the first phase, spread over the next six months, Space Hospitals will invest around Rs 25 crore. "Our target is to establish around 10,000 centres in the next five years," said A Sivakumaran, CFO, Space Hospitals.

The company will also launch 10 mobile telemedicine units in the next one year, with two units in each of the four states -- Tamil Nadu, Andhra Pradesh, Maharashtra, Kerala and two more in New Delhi. Around Rs 10 lakh will be invested in these mobile units.

“We are also going to extend our services to the Asian countries, Middle East and Africa. We are still in the preliminary stage of discussions and will be able to formulate concrete plans after considering a few issues like connectivity tariffs. However, we intend to hit the international market in another six months," said Sivakumaran.

Space Hospitals is in talks with institutions like BRS Hospital, SKS Hospital, Meenakshi Mission Hospital, Kovai Medical Centre and Medindia for further associate hospital tie-ups.

For the setting up of satellite medical centres, it is considering tie-ups with M V K Nursing Home in Tanjore, Sangeetha Hospital in Coimbatore and Saravana Hospital in Madurai.

Space Hospitals expects around 15 percent of doctor-patient consultation in India to switch over to telemedicine services in the next five years.
 
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