India Healthcare Bulletin - December 2012

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Content

ndia&Healthcare&Bulletin&&

n initiative towards better healthcare access in India

www.indiahealthprogress.in) &

A!Monthly! ! ! ! ! !Volume!XXVIII,!Issue!10.!Dec!2012!!

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Edit!Speak!by!Aman!Gupta!

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Stringent!policies,!greater!government!

spending!the!need!of!the!hour!

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Pharma!innovations!can!accelerate!access!

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Correcting!priorities!for!

achieving!health!for!all!

!EDIT.SPEAK%

Universal%Health%Care:%One.Stop%Agenda%!We!are!at!a!juncture!in!the!history!of!Indian!health!care!when!Universal!Health!Care!(UHC)!has!finally!been!understood!as!the!mos

valid!goal!for!the!countrys!notOsoOstrong!healthcare!sector.!This!is!true!not!only!for!the!private!players,!but!also!the!governmethat!plans!to!incorporate!the!ideal!in!the!12

th!Five!Year!Plan!(2012O17).!!!

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As!another!year!has!passed!by,!we!know!that!time!is!short!and!work!is!immense!to!make!the!vision!of!an!allOinclusive!healthca

system!a!reality.!2012!by!and!large!turned!out!to!be!a!good!year!for!the!Indian!health!sector.!A!major!accomplishment!was!t

completion! of!a! full! year!without! one!of! the!major!communicable!diseases!! polio.!n! January! 13,!2012,!we! proudly!went!

without!a!single!case!of!the!debilitating!illness!being!reported!from!any!part!of!the!country.!!

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Such!a!major!achievement!makes!one!think!that!when!such!success!can!be!achieved!with!focused!attention!and!careful!planning!i

the!case!of!one!disease,! it!can!also!be!attained!for!other!ailments!as!well!as!known!areas!with!deficiencies!in!the!sector.!Thi

wherein!lays!the!importance!of!structured!discussion!and!careful!planning!by!various!stakeholders!to!achieve!health!for!all.!!!!!!!

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As!a!platform!that!brings!together!stakeholders!of!the!sector!to!discuss!ways!to!improve!access,!India!Health!Progress!(IHP)!haworked!vociferously!to!help!raise!collective!voices!and!channelising!them!to!form!a!roadmap!for!future!course!of!action!to!achiev

universal!health!care.!In!the!past!year,!IHP!held!roundtables!for!NCDs,!conducted!panel!discussions!and!media!events,!along!w

various!stakeholders,!to!highlight!innumerable!issues!that!need!attention!in!the!area!of!healthcare!access.!!

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Events!like!the!flagship!Health!Access!Week,!IHPOsupported!PPI!Conclave!on!Improving!Access,!Innovation!&!Reach!of!Health!car

in!India,!as!well!as!the!forums!partnership!with!Cancer!Patients!Aid!Association!&!WH!on!World!No!Tobacco!Day!to!promote!t

cause!of!healthy!living!were!a!huge!success!and!helped!in!spreading!the!message!of!UHC.!!

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It!has!been!understood! that!healthy!partnerships!are! to!be!nurtured!among!different!proponents!of!UHC!so! that!each!one! c

contribute!their!bit!without!hurting!the!others!interests.!Collaborative!efforts!are!needed!to!make!India!progress!on!the!healt

front.!Moreover,!contributions!of!global!pharmaceutical!companies!must!be!taken!into!account!and!their!potential!in!leveragi

healthcare!work!understood!instead!of!making!villains!out!of!them.!!!!!!!!!!!!

Technological! innovations! in!medical! equipment,! facilities! and! treatments! is! one! the! most! important! aspects! that! should!

stressed! upon! at! all! levels.! Research! and! development! methodologies! should! be! such! that! they! are! progressive! and! lead

continuous!medical!education!of!our!doctors!and!other!medical!professionals.!!!!!

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In!the! years! to!come,!three!key!principles!that!will!drive! industry! transformation! are!affordability!of! care,!overall!wellness! a

patientOcentricity.!We!must!make!sure!that!all!must!cooperate!to!achieve!these!and!start!taking!concrete!steps!in!2013,!witho

wasting!any!time.!

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!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!"Aman"Gupta,"Principal"Advisor,"I


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Time%to%act!%

Stringent%policies,%greater%government%spending%needed%for%effective%health%system%!

In!a!vast!country!like!India!with!varied!demographics!across!its!length!and!breadth,!the!inconsistency!of!healthcare!access

appallingly!severe!!between!the!rich!and!the!poor!as!well!as!the!urban!and!rural!OO!to!be!ignored.!Lack!of!basic!prima

health! care! in! itself! is! a! big! problem! in! villages! and! small! towns.! The! number! of!medical! facilities! as!well! as!mediprofessionals!is!not!sufficient!enough!to!provide!care!to!the!more!than!1.2!billion!people!of!the!country.!Recent!estimate

show!that!there!is!only!1!physician!for!more!than!1,700!people!in!the!country!with!the!doctor!to!nurse!ratio!being!at!

abysmal!1:1.6.1!!With!a!reported!18%

2! shortfall! in!Primary!Healthcare!Centres! in!the!country,! the!problem!of!inadequa

cannot!be!starker.!!

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The!main!culprit!sighted!by!most!is!the!insufficient!public!spending!on!health.!Merely!1.4%!of!the!GDP!was!being!spent!o

such!a!crucial!sector!in! the!last!five!years.!Even!though!the!governments!decision!to!increase!expenditure!to!2.5%!of! t

GDP!is!a!very!welcome!move,!much!more!needs!to!be!done!to!cover!the!shortages.!!!!!

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!Source:%CII.Mckinsey%report%titled%India%Healthcare:%Inspiring%possibilities,%challenging%journey%

LMIC:"Low"and"Middle"Income"Countries"

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The!health!policies!of!the!government!also!need!a!revisit!as!they!have!mostly!focused!on!communicable!diseases!so!far.!

recently,! it! has! been! realised! that! nonOcommunicable! diseases! (NCDs)! such! as! hypertension,! heart! disease,! cancer! a

diabetes!have!grown!to!become!another! real!menace!for! the!country.!Environmental!changes;!threat!of! illnesses! such!

bird!flu!and!H1N1;!and!increasing!burden!of!mental!diseases!also!pose!as!additional!troubles!for!the!healthcare!systems!o

the!country.! Infrastructure!problems! such! as! lack!of! sanitation,! potable!water! and!basic! cleanliness,!which! were! earl

thought!to!be!prominent!in!the!rural!areas,!are!also!troubling!the!urban!populace.!!

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!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!1!National!Development!Council!to!discuss!shortage!of!doctors,!nurses!2

!Unhealthy!at!65:!India!has!76%!shortfall!in!government!doctors!
http://articles.timesofindia.indiatimes.com/2012-08-16/india/33232332_1_health-centres-chcs-health-infrastructurehttp://articles.timesofindia.indiatimes.com/2012-12-27/india/36021266_1_nurse-ratio-health-workers-12th-plan


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Filmmaker!Yash!Chopras!death!in!Mumbai!due!to!mosquitoOborne!dengue! is!a! tragedy!in!the!urban!healthcare!system

the! country.!Moreover,! health! reforms! such! as! Universal! Health! Coverage,! Right! to!Health! and! National! Urban! Hea

Mission!have!become!simply!talking!points.!These!must!be!now!introduced!as!stringent!policies!and!implemented!all!over.

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Pharmaceutical%Innovations%Can%Accelerate%Access%!!

New!therapies!benefit!a!lot!of!patients!by!minimising!their!sufferi

Take! for! example! the! scope! for! development! of! new! medicines! f

treatment! of!one!of! the!most! common! nonOcommunicable!diseas

diabetes! which! affects! nearly! 347! million! people! the! world! peop

According! to! a! report! released! by! the!Pharmaceutical! Research! a

Manufacturers! of! America! (PhRMA),! innovative! biopharmaceuti

research! companies! are! currently! developing! as! many! as! 221! ne

medicines!to!help!diabetics.!With!fresh!introductions,!there!is!a!scop

to!improve!patient!condition,!avoiding!complexities!as!well!as!reduc

fatalities!that!the!debilitating!disease!can!cause.!!!!!!!!!

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Innovation!is!a!key!tool!by!means!of!which!the!pharmaceutical!industry!can!help!reach!the!goal!of!universal!access!to!hea

care.!The!sector,!which!not!only!manufactures!known!drugs,!is!also!responsible!for!introducing!newer!medicines,!medi

tests!after!confirming!their!safety!and!quality.!Moreover,!many!have!involved!themselves!with!effective!social!initiatives!

well!as!research!and!development!activities!that!benefit!millions!of!people!across!the!socioOeconomic!spectrum.!The!need

to!put!aside!the!negative!perceptions!about!the!sector!and!start!working!jointly!for!the!larger!benefit!of!mankind.!Success

partnerships!have!been!fostered!to!help!leverage!the!investments!by!pharma!corporates!towards!social!benefit.!Associatio

such!as! rganisation! of! Pharmaceutical! Producers! of! India! (PPI)! encourage! CSR! initiatives! by!memberOpharmaceuti

firms.!!!!!!

Similarly,!many!Indian!pharma! companies! are!now!conducting! research!

and! development!work! to! improve! drug! quality! and! cost! effectiveness!

with!their!average!R&D!spend!nearing!almost!6%!of!their!total!sales!!for!

e.g.!Lupin!spends!8.5%;!Biocon!7.5%;!Glenmark!7.25%;!Dr!Reddys!6.8%;!

Cadila!Healthcare!6.4%!and!Ranbaxy!6.1%3.!However,!this!is!much!lower!

than!what! the! global! pharma! companies! in! the! US! and! Europe! spend.!

More! has! to! be! done! by! the! Indian! pharmaceutical! industry! in! this!

increasingly!important!sphere!to!innovate!on!drugs,!!

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People!have!now!started!to!understand!that!only!branded!drugs!are!not!

safe;! generic!drugs,!that! are!usually!cheaper! than! their! counterparts,! can!also! serve! the!purpose!with! good! quality.!T

approval!of! the!National!Pharmaceutical!Pricing!Policy! (NPPP)!in!2012!came!as!good!news;!but,!unless!spurious!drugs!a

eliminated!and!other!factors!that!hinder!access!corrected,!it!is!unlikely!to!benefit.!With!the!NPPP,!348!drugs!of!the!Essent

Drug!List!were!brought!under!price!control,!paving!the!way!for!cheaper!drugs.!It!still!needs!to!be!seen!how!well!this!policy

implemented!in!the!country!with!initial!hurdles!of!data!on!prices!and!voices!by!some!in!the!pharmaceutical!industry!on!t

policy!hurting!investment!sentiments!already!becoming!matters!of!concern.!!

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!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!3

!Is!pharma!steering!Indias!tryst!as!a!major!R&D!hub?
http://zeenews.india.com/business/news/interviews/is-pharma-steering-indias-tryst-as-a-major-randd-hub_55926.html


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Correcting%Priorities%to%Achieve%Health%for%All%%%%!

A!lot!of!discussion!has!gone!by!in!getting!all!stakeholders!on!one!page!in!understanding!that!this!goal!will!require!concert

and!collaborative!efforts.!It!is!time!for!all!to!come!together!and!make!the!vision!of!an!allOinclusive!healthy!India!a!reality!i

the!year!ahead.!!

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81/2,!Second!Floor,!pposite!STC!Housing!Colony,!Shri!Aurobindo!Marg,!Adhchini,!New!Delhi!!110017!

Tel:!+91O11O46668640!|!Fax:!+91O11O!4666865!|!Web:! www.indiahealthprogress.in!

!

Follow!us!!

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Increased%Spending%

Public!health!spending!needs!to!be!increased!manifold!and!

moreover!the!private!sectors!investment!capabilities!must!be!

channelised!for!the!growth!of!Indian!health!industry.!When!

we!know!that!lack!of!finances!is!the!first!roadblock!to!

universal!health!care!in!the!country,!concrete!measures!must!

be!taken!to!improve!funding!in!the!sector.!

More%Focus%on%Preventive%Model%%

There!has!to!be!specific!emphasis!on!the!preventive!model

care,! besides! the! curative! aspect.! VaccineOpreventab

communicable!diseases! such! as!polio!as!well! as!preventab

NCDs!that!are!caused!by!distorted!lifestyles!can!be!curbed!

increasing! awareness! among! the! masses! about! them! a

ways! to! avoid! them.! Knowledge! and! understanding! abo

illnesses!can!help!people!manage!their!health!accordingly!an

also!have!a!positive!lifestyle!conducive!to!wellness.!Technology%and%Innovation%

These! can!overcome!many!hindrances! in! healthcare! access!

and! also! help! in! reducing! medical! costs,! making! it! costO

effective!and!affordable!to!the!masses.!New!diagnostics!and!

treatment! methodologies! are! to! be! evolved! at! every! stage!

with!the!help!of!research!or!by!duplicating!best!practices!in!

other!countries.!Furthermore,!the!use!of!mobile!technology!in!health,!known!as!mHealth,!can!help!increase!access!to!care!as!

mobile! phones! have! become! the! best! mode! of! instant!

communication.!!

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Human%Resource%Development%

Besides! increasing! the! number! of!medical! personnel! in! t

country,! it! is! also! essential! to! focus! on! their! expertise! a

skills.! Continuous! medical! education! programmes! based!

new!innovations!must!be!held!across!India!to!build!capacit

of!our! doctors! and!other!medical! staff.!Care! should! also!taken!to!empower!doctors,!nurses,!paramedics,!chemists!a

counsellors!who!take!care!of!the!ailing!day!in!and!day!out.!!

Public%Private%Model%

Private!funds!and! investment!must!be!tapped!and!the!reach!

of!the!private! sector!utilised!to!make!good!health! reach!the!

remotest!of!all!areas.!The!dream!to!reach!each!patient!with!

quality!health!care!can!be!achieved!this!way.!The!corporates!

can,! not! only! help! in! infrastructure! development! but! also!

training! of! medical! personnel,! CSR! programmes! and! public!

advocacy! initiatives.! Public! Private! Partnership! (PPP)!successes! such! as! the! Karuna! Trust! that! manages! primary!

health! centres! in! 8! states,! Yeshasvini! scheme! in! Karnataka!

and! Gujarats! Chiranjeevi! scheme! for! maternal! and! child!

health!must!be!replicated!across!the!country!

Drugs%Access%

Spurious! drugs! have! emerged! as! a! dark! area! in! the! Indi

healthcare! industry.! Safety! and! quality! control! are! keys!

eliminate!this!menace!as!the!level!of!substandard!medicine

has!also!not!been!ascertained.!Development!of!new!drugs!

well! as! vaccines! needs! to! be! taken! up! by! the! Indi

pharmaceutical! companies! at! a! much! larger! scale! th

already!being!done.!

Mental%Health%

Mental!illnesses!such!as!anxiety!and!depression!have!becom

commonplace! in! the! country,! but! there! is! hardly! anythi

being!done! at!a! larger!level!to! enhance!awareness! for!the

prevention!and!treatment.!The!stigma!in!the!society!regardin

these! disorders! also! has! to! be! worked! on.! Psychosoc

support!by!therapists,!counselors!and!psychiatrists!is!require

in! management! of! several! longOterm! diseases! apart! fro

mental!illnesses.!

Patient.Centric%Approach%

Finally,!only!a!patientOcentric!approach!will!lead!to!the!victory!

of! all! efforts! towards! universal! coverage! of! health.! Timely!

diagnosis!and!prompt!treatment,!apart!from!affordability!and!

quality,!is!what!the!patient!OO!the!end!user!in!this!case!!seeks.!

Any!policies,!plans,!discussions!and!reforms!in!the!healthcare!

sector!must!keep!patients!in!mind.!
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Documents

India Healthcare Bulletin - December 2012