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Monday 10 December 2012

Featured post- mHealth fighting malnutrition


Melghat: a synonym for malnutrition

Malnutrition is a byword in the forested hills of the Melghat region inhabited mostly by Korku Adivasis. Every year 400-500 children between the ages of 0 and 6 die in the region, comprising Chikhaldhara and Dharni taluks, according to official figures from 2005.

The Problem: Thousands of kids die every year in the tribal area of Melghat (Maharashtra, India) due to lack of medical attention and nutritional support. Increased incidence and rapid spread of infectious diseases such as pneumonia, typhoid, and dysentery are primary cause of high child mortality. Situation worsens during monsoon when the food supplies are low and the communicable diseases are at their peak.

Melghat is also a place known for high infant mortality rate. Some reasons for the health crisis in Melghat include lack of infrastructure, under-equipped and under-staffed public health and ICDS centres, the tradition of early marriages and early motherhood, lack of sanitation and clean drinking water facilities and the tribals' blind faith in bhumkas (quacks).

Failed Operations of the past: When the Maharashtra government first recorded the figures of child deaths due to endemic malnutrition in the remote villages of Melghat, shocking numbers were revealed.Almost two decades later, even though the government figures show a substantial drop in the number of malnutrition deaths, social activists and health-coordinators working in the impoverished area say that the authorities pass off such deaths as still-births.

The reality continues to bite with the data recorded just before monsoon this year, indicating 509 malnutrition induced deaths during past year, until March 2011. Every year, hundreds of children of Korku tribe in the tehsils of Melghat in the Satpura ranges fall prey to starvation and malnutrition. While the government records indicate figures ranging from 400-525 in the last five years, health activists working among the tribals tell a different story.

Madhukar Mane, Health Coordinator with NGO Maitri, which organises monsoon campaigns to prevent deaths in the precarious season, says: "The figures are certainly better than the late 90s but the numbers are still very high in the tehsils of Dharni and Chikhaldhara. Government records child deaths under two categories: still birth and neonatal. What happens is that they write off several deaths as still births so that the infant mortality rate (IMR) could be kept under check.

Ray of Hope: mhealth is now bringing about a change in India. My two adopted ones- Bongu and Priti along with several others are now fighting malnutrition in their region..I adopted these two angels with the help of World vision India.

The community health workers in Melghat are given the latest weapon to fight against the silent killer – malnutrition. It's a mobile phone pre-loaded with an application called CommCare. "Whenever a pregnancy is reported, I register the women's name and other details via the phone," a community health worker explains.

Once the registration is done, the software gives her the woman’s expected delivery, check-up and immunisation dates. The phone also has pre-recorded messages on maternal and child health that can be played for the women.

Once data is collected, it is saved on a central server of World Vision India, a non-profit organisation that works closely with the government, which distributed these phones. The information then helps in monitoring the health of pregnant women, lactating mothers and young children. The government is now toying with the idea of expanding this successful service to other districts of the state.

Recommendations: Government need to provide access to basic healthcare using mHealth/Telemedicine. About 50 per cent families in Melghat are below poverty line with a high rate of unemployment. Weak mothers often deliver children in grade 1 malnutrition.

It almost instantly deteriorates to grade 2, and then 3 & 4. The nearest emergency health care is about 120 km away that too without a child specialist or medical equipment. About 39 children are suffering from grade 4 malnutrition while 442 fall under grade 3 here.

Here are some of the basic needs of the people in Melghat:
  • Proper Scientific Nutrition, including Micronutrients.
  • Preventive Health
  • Mother and Child Care
  • Reactivating Comprehensive Education system
  • Transportation & Roads
  • Availability of permanent Employment Guarantee during the non-agricultural season.

The health of Melghat cannot change overnight. But tough monitoring and creative solutions along with the State-led ones, the primary being the crucial Right to Food law, can hopefully nurse it back to good health in future.

Comments welcome!

References
Dr A. Ghosh- Team BHP
Commcare
http://www.hindustantimes.com/News-Feed/Columns/Spoon-feeding-Melghat/Article1-953028.aspx
http://indiatoday.intoday.in/story/government-fudges-mortality-records-in-melghat/1/153486.html
http://supriyassule.com/en/projects-and-developments/melghat

Saturday 24 November 2012

The Real India-mHealth & beyond Part 3


Tuberculosis- TB is caused by a bacterium, Mycobacterium tuberculosis, that the WHO says infects one third of the world’s population. Between five and 10 percent of infected people develop the disease and become contagious at some point in their lives. (For those with HIV or AIDS, however, the rate is much higher.)

The Bigger problem- India is the highest TB burden country with World health Organisation (WHO) statistics for 2010 giving an estimated incidence figure of 2.3 million cases of TB for India out of a global incidence of 9.4 million cases. The WHO statistics also show that India is 17th out of the 22 high burden countries in terms of TB incidence rate. The estimated TB prevalence figure for 2010 is given as 3.1 million. It is estimated that about 40% of the Indian population is infected with TB bacteria, the vast majority of whom have latent rather than active TB.
Compliance issues in Treatment- To treat TB, the WHO recommends the so-called DOTS (Directly Observed Treatment Short-course) strategy, where patients take medication under supervision from health staff. Daily supervision of treatment is too demanding for most of our patients and instead implements self-administered therapy with patient education and support to ensure adherence. In many countries affected by conflict, access to health structures is limited for the population. Conflict interrupts travel and makes people fearful of leaving their shelters to seek assistance. It can also lead to the collapse of existing health systems.In India in 2010 292,972 people needed TB re-treatment because of initial treatment relapse, failure or default.

In Focus- Operation ASHA

Operation ASHA is a registered non-profit that has taken TB treatment to the doorsteps of 5.37 million individuals living in disadvantaged areas. It operates in over 2,053 villages and slums in six states spread across India and Cambodia. The effort is self-sustainable and is using technology to reach out to millions everyday.

Establishing Centres- Operation ASHA establishes tuberculosis (TB) treatment centers within existing community locals (for example, strategically placed shops, homes, temples, or health clinics). Under the World Health Organization’s Directly Observed Therapy (DOTS), patients must take their medicines under the supervision of a health care worker. The model is designed to help patients procure their medicines conveniently without wasting time, spending money on transport, and losing wages. This also drastically reduces the effort, time and money that patients have to invest in taking their medication, which is key to ensuring that patients complete the entire course of treatment.

Training- Operation ASHA trains community members (often former patients) to become tuberculosis health workers who are responsible for identifying new patients, ensuring adherence to the drug regimen, and carrying out regular educational campaigns. Operation ASHA works closely with the Government of India, who provides them with free medicines and diagnostic services. After a center has been established for two years, the government provides a grant for every patient cured, making OpASHA’s centers financially self-sustaining.

Building Compliance through technology- Ensuring patient compliance is important because of the threat of multi-drug resistant tuberculosis (MDR-TB), which has become one of the world’s largest public health issues. Resistant strains of the disease can take up to two years to treat (in comparison to the standard 6 month regimen). Second line medicines have more severe side effects and can also cost 50-200 times more. Such unrealistically high costs are essentially a death warrant to those below the poverty line. To combat the rising MDR-TB epidemic, OpASHA launched eCompliance, a biometric initiative in collaboration with Microsoft Research, which uses fingerprint scanners to track patient visits.


The system consists of three parts: 
  • a netbook computer, 
  • a USB fingerprint reader (from Digital Persona), 
  • and a GSM modem that uploads the visitation logs (via SMS) to a central location. 


Patients scan their finger every time they take medication, and these logs are visualized in the central office to monitor medication delivery. Missed doses trigger an SMS notification to managers, who ensure timely supervision or counseling to the patients and health workers involved. The health worker is then required to do a follow-up visit within 48 hours to deliver the medicines and supplementary health education. 

These home visits are also confirmed by biometrics. Currently the terminal is used daily in over 40 treatment centers, spanning Delhi, Mumbai, and Jaitpur; Operation ASHA is aggressively expanding the deployment to over 225 centers around the world. To date, the technology has enrolled about 2,700 patients and logged over 50,000 supervised doses. The biometric records are used to automatically generate reports to the government and other stakeholders.

With the help of eCompliance, Operation ASHA has reduced its default to 1.5%, which is much lower than other institutions. The cost of treating a patient for the entire therapy of is US $50.


References/Credits:

TB statistics of India- TB India 2011 Revised National TB Control Programme Annual Status Report, New Delhi, 2011 www.tbcindia.nic.in/documents.html#

Doctor without borders- http://www.doctorswithoutborders.org/news/issue.cfm?id=2404

Operation ASHA- http://www.opasha.org/



Saturday 10 November 2012

The Real India- mHealth & beyond (Part 2)


Read The real India- mHealth and beyond- part 1 here



Doctor on Call Services-
Rural India- The Doctor to patient ratio in Bihar is 1:3500, which is far behind the national average of 1:1700. Bhore committee, set up to recommend improvements in the Indian Public Health system, had suggested a ratio of 1:1000. It is felt that without addressing this problem, all promises made by the state government will remain a distant dream. 

There are around 30,000 registered doctors in the state – both government as well as those engaged in private practice. The condition is more or less same in the state of AP (Andhra Pradesh)  as well. In AP, around 6 lac (6,00,000) people go untreated every day.

Mediphone- A great example of 3 different stakeholders joining hands across the value chain in India. Medibank (Australia) ties up with Religare Technologies (A Fortis Company) and Airtel for launching the service to provide Medical prescription in less than $1 across India.

Service positioned for:
1. Middle class population especially in Tier 1 cities where access to health information is there but people demand convenience and don't wish to drive down to a clinic for trivial issues especially in the wee hours. Hence Consumer is willing to pay for a service where he can get OTC prescription over the phone for conditions like stomach ache, Headache and food-allergies.
2. Population in Tier 3 cities where access to health information is not much, there are myths around certain conditions, patients need second opinion and counselling to make informed decisions and where acute health services aren't available 24X7. Hence Consumer is willing to pay for a service where health specialists can help understand these conditions and available treatment methodologies better.
3. Home bound and elderly population that needs long term continued care and attention.

Service is now evolving to:
1. Set up Helplines in conjunction with state governments for rural people as well as for the under-served across India.
2. Develop mHealth apps for mobile phones for population that wish to browse, read and understand health information and then impart it to the whole community (like Aanganwadi, ASHA workers). Also, develop apps for premium smart phones.
3. Provide Health classifieds services "Healthline 24X7" for finding the right doctor say 0.5 miles away from your house, look for a clinic that accept credit cards and Paediatric doctor who does home visits.

STARTUP Idea- By 2020, it is estimated that depression will be the second biggest cause of morbidity after heart ailments, as it triggers various other diseases by lowering immunity and increasing malignancy. Unfortunately, in India, people don’t take the disease seriously and it goes untreated in almost 80-90 per cent of cases due to stigma, myths, and lack of awareness. Even though crores of rupees have been sanctioned for National Mental Health Programme, the money does not reach where it should because of corruption. 90% depression cases stay untreated in India. We need a dedicated HELPLINE for supporting depressed patients in India today.

Potential: There is a great potential for this. Depression is the most common mental ailment after anxiety disorder afflicting around 15-20 per cent of the population. An estimated 75 per cent of people who commit suicide are found to be suffering from depression. With treatment, 70-80 per cent of depression cases can be cured. If neglected or left untreated, depression increases steroid levels, which in turn reduces immunity, decreases bone mineralisation leading to osteoporosis and early arthritis. In the long run, it increases the risk of malignancy, heart attacks, and decreases the chances of recovery from chronic and cardiac ailments by 2.5 to 3.5 times.

To be continued..........Ideas welcome...........


Friday 2 November 2012

The real India- mHealth and beyond ICT


After spending 20 days on-ground with PHCs and while supporting some of the major initiatives in India, I was tempted to do some cut-throat analysis. I realized that 25% of the total Income generated in India is in the hands of mere 100 rich families. What's more! this huge gap is increasing day by day. After independence, the valley has only widened up between the rich and the poor and the growth that we envisage is still miles away from the hands of a common man.


Photograph courtesy @Shashwat Nagpal
Over 72%  (that would be over 620 million) of India’s population lives in its 638,588 villages. It is hard to believe but in India, a common man is most indebted to healthcare after dowry. Most families earn less than $1/day and some of the major initiatives by NGOs suffer as there is so much distrust about Government policies and efforts in the country.

In villages, healthcare in India still starts from Security, clean drinking water, better sanitation facilities and good roads. Then comes the demand for basic access to healthcare. ...

There is 1 doctor per 1000 people, but there are 3.3 million NGOs, i.e. 1 NGO per less than 400 people in India. As per 2011 stats (World Bank), the % of GDP contributed to healthcare in India is 4.2. We are laggards and countries like Afghanistan (7.8%), Yemen Rep.(5.2%), Uganda (9%), Nepal (5.5%) are doing much better than us. The count of NGOs is many times the number of primary schools and primary health centers in India. My intention here is not to blame the Government here but to help understand the ground realities better.

Most of India’s estimated 1.2 billion people have to pay for medical treatment out of their own pockets (That is more than 80% of the total health expenditure as per 2011 stats) . According to a report by the Federation of Indian Chambers of Commerce and Industry- Less than 15% of the population in India today has any kind of health-care cover, be it community insurance, employers’ expenditure, social insurance etc. One of the major reasons that India’s poor incur debt is the cost of health care. Ajay Bakshi, a good friend and CEO of Max Healthcare mentioned, "We charge our patients about $400 to $500 per night in our hospital. But rather than treat one million customers at this rate, how do we instead treat 100 million customers at $10 per patient? The move from a high-ticket, low-volume operation to a low-ticket, high-volume operation is very difficult. Nobody in our industry knows how to do this.”

The question hence is, Can mHealth bring down healthcare costs? Is it a far-flung reality for the common man or feasible? The answer is YES. Here I am mentioning one such Case study that will help us understand the revolution mHealth can bring to India's otherwise waning healthcare system.


E-HealthPoint- E-Health Point combines water and wireless to provide healthcare in rural India- E Health Points (EHP) are units owned and operated by Healthpoint Services India (HSI) that provide families in rural villages with clean drinking water, medicines, comprehensive diagnostic tools, and advanced tele-medical services that bring a doctor and modern, evidence-based healthcare to their community. They provided 4 basic things:
1. Rural broadband
2. Good telemedical software
3. Modern point-of-care diagnostics mobile diagnostics
4.  Cheap water treatment

This is a for-profit social enterprise. They pay their doctors about 30,000 INR per month.  They pay their village health workers as well.  They pay their unit staff that they hire and train from the village.  They also re-cover those costs with patient fees.That's what's amazing - that they were able to do a reasonably good service, in an area where there wasn't any, and make enough to cover their costs.  That's what's revolutionary - that it's sustainable.

To be continued..Ideas welcome..If you wish to share your views via our questionnaire, Take our Survey http://www.surveymonkey.com/s/88HTCN2


References: http://data.worldbank.org/indicator/SH.XPD.TOTL.ZS
http://www.indianexpress.com/news/first-official-estimate-an-ngo-for-every-400-people-in-india/643302/1
http://www.telecomtv.com/comspace_newsDetail.aspx?n=49444&id=e9381817-0593-417a-8639-c4c53e2a2a10

Sunday 20 May 2012

mHealth in India- What works and what not?


From remote monitoring to disease management, wireless technology is helping to improve healthcare outcomes and address the healthcare worker shortage. In the U.S., chronic disease treatment costs more than $1.4 trillion each year, but using mHealth could mean a savings of more than $21.1 billion per year.

But in India there is this unique pattern of adoption and push that is to be understood. Over the last decade, telehealth in India has been primarily facilitated and driven by government funding. The government now has a majorpolicy initiative in mobile health. However, in pursuing the broad initiative there is a danger that some of the smaller components can get lost, and this is probably what has happened to telehealth. Many government-driven telemedicine programmes have failed to live a long life. It is no secret that these programmes do not have a successful business model and die after the government grants run out. But if you are a medical device, mhealth app or Disease management software company based out of US or Europe eyeing India as a market-> Follow the money-> i.e. Government contracts.


As a mHealth Consultant, we tried several innovations in the country (already 67+ projects in my kitty) and here is the report card as far as stakeholders are concerned. No wonder, the maximum push is from the Government side but the things that are lacking is a concrete business model? So does that mean there is no for-profit model for mHealth in India.

The answer is YES, there is but we are still gearing up. I have met several companies from Switzerland, Israel, US and Europe and the whole reason for them to enter the Indian market was cashing on consumerism and scale. Remember, things may not turn out in your favour for the first 3 years if you are working on a for-profit model in India, so you have to be patient and try and work with the right partners and channels. However, quick money is always something that Government tenders provide.

As far as services are concerned Remote monitoring in India has not taken up as yet. Below given is a infograph on some of these services and their adoption in the country. Also refer to our survey report on Diabetes monitoring.

At this point in time, more than 4 large states in India are looking to set up a Non-emergency help line for consumers and people who live in rural areas and do not have access to basic health. Tele-triage companies from US and Europe have already submitted their interest for the same. Similarly, mobile clinics, telemedicine centres and health information on mobile phones is catching up as priorities amongst Indian Government. We all know about Dr SMS - an initiative of Kerala Government. (Healthcursor Consulting Group has prepared a report on several such reforms that were implemented by Govt. of India from the year 2005 onwards and lessons learnt - available for a price on the website).

There appear to be a number of steps required if telehealth in India is to keep up the pace of development, as we move into what is now being called the era of m-health, involving visual media, skype and hub and spoke based remote health service delivery. This area is changing extremely rapidly and is increasingly migrating away from the public sector in India, where most of the developmental work has occurred, and into the private sector. Some of the factors that lack in Govt. based implementations here are:

1. Patient satisfaction – do patients like the technology?

2. Clinical efficacy – how well we can treat the patients remotely rather than face to face?
3. Business case and sustainability – development of clear metrics to measure the project, including for example decreasing number of transports, reduced rate of hospitalisation and increased productivity. Many of the issues require consideration within the domain of m-health in India are also relevant to other countries. M-health will significantly change the way that health-care is practised in future, and it is clear that it is the human factors that are more difficult to overcome, rather than the technological ones.

Sunday 29 April 2012

mHealth- Innovation for Maternal & Child Health in India


Dear Friends, It is been a while since I wrote my last post. Life hasn't been easy after we claimed the title of "the only niche mHealth consulting company" in India. But we are doing fairly good by going just well.

This post of mine is centred towards Disease surveillance and missing links in India. Very recently when I joined the UN's Best Practices and Innovations Working Group for Maternal and child health, I went deep dive to understand the problems in this sector. The revelations were quite alarming...
  • Infant mortality remains as high as 63 deaths per 1,000 live births. Most infant deaths occur in the first month of life, with up to 47 per cent in the first week
  • Diarrhoea remains the second major cause of death among children, after respiratory-tract infections. Unhygienic practices and unsafe drinking water are some of its main causes.
  • India has an estimated 220,000 children infected by HIV. It is estimated that 55,000 to 60,000 children are born every year to mothers who are HIV-positive.
  • With an estimated 12.6 million children engaged in hazardous occupations, India has the largest number of child labourers under the age of 14 in the world.
  • Children in India continue to lose their lives to vaccine-preventable diseases such as measles, which remains the biggest killer. Tetanus in newborns also remains a problem.
  • Anaemia affects 74 per cent of children under the age of three, more than 90 per cent of adolescent girls and 50 per cent of women. 


Anaemia led post partum haemorrhage and death are common in India. A mild anemic condition may have no obvious symptoms. Individuals with moderate anemia may complain of headaches, fatigue, and lethargy. Severe anemia can cause shortness of breath, dizziness, chest pain, or palpitations. In a rural setup however, this goes easily un-noticed. Spoke to a few doctors locally and realised that Asha workers can do it for them BUT ARE NOT EQUIPPED...

Tests: Iron levels are typically only taken during the first prenatal visit and sometimes after 28 weeks gestation. Therefore, it is important for a pregnant woman to notify her healthcare provider if she notices any associated symptoms. Although one may not be anaemic in the early stages of pregnancy, as the pregnancy progresses the foetus draws on the woman's resources and anaemia can develop.

These facilities are either un-utilised or are not available- mHealth solution- Myshkin and his team have developed a portable, mobile phone sized device to diagnose and monitor anaemia non-invasively i.e. without needles. The technology works on an optical principle and gives out results instantly. Once detected, Anaemia can be easily cured with iron supplements.



Diarrhea-  I interviewed a few women from a village and asked what do they do when they realise that their kid has got diarrhea:
1. Increase Fluids
2. Decrease Fluids
63% of them said reduce fluids...Many of you will say, How sad! they don't even know. The answer is think for a second???

The water in this area is so polluted that the more the kid consumes water, the more ill he gets. These families know about Oral Rehydration Solutions, juices, how to prepare it at home and all of it. Is the supply of ORS packets sufficient? In India healthcare still starts from clean drinking water, better roads and proper sanitation facilities.

Innovations for Poverty Action (IPA) has developed a chlorine delivery mechanism that is very cost-effective and highly popular with end users—the chlorine dispenser. IPA has demonstrated that chlorine dispensers achieve usage rates of nearly 70%, while dramatically reducing the cost of household chlorination by cutting packaging and transportation costs. Chlorination has been proven to reduce the incidence of child diarrhea by 20-40%.

Baby blankets- IN FOR MATION BLANKET FOR NEWBORNS A blanket that keeps newborns warm or cool depending on the weather to provide immediate and lasting protection for the infant as it develops. As important, the blanket is imprinted with a very basic bible of information for mothers to reference as their little one continues to grow. The Blanket features a code for scanning, so health workers can reference a database to quickly register the child, and keep tabs on it as it develops.

mHealth- For tracking of these supplies, wireless technologies can be utilised. Uniphore is a healthcare startup and one of few technology companies that is working to impact rural India through a for-profit model. The startup designs and delivers mobile solutions for businesses using Multilingual Speech Recognition and Voice Biometrics in customized IVR and GRPS applications — so that businesses can enable customers to get information and do transactions from remote places and in their local languages (regardless of literacy level, language capability, connectivity or location.)

Pneumonia- India records the highest number of child pneumonia deaths globally, but is among the only four of the 15 countries with the highest child pneumonia death toll that is yet to introduce the newest generation of pneumoccal vaccines.

A Pneumonia progress report, 2011, released by the International Access Vaccine Centre (IVAC) and John Hopkins Bloomberg School of Public Health on Wednesday shows that India recorded 3.71 lakh child pneumonia deaths in 2008, but till 2010 had "not introduced" the HIB vaccine against pneumonia.

mHealth- Plug -in Technology For Mobile Phones Diagnoses Pneumonia- Researchers at the University of Melbourne in Australia are adapting cell phones to help health workers quickly diagnose pneumonia. The team has developed a low-cost oximeter, a device that measures the oxygen content in red blood cells by tracking the absorption of red and infrared light waves as they pass through a patient’s fingertip. This can be plugged into a smartphone with special diagnostic software to analyze readings obtained from the sensor and determine a patient’s health. The next step is expanding the prototype to work with simpler cell phones.
 In the last decade or so, except for GDP growth, in most development indicators, India has significantly lagged behind the rest of the world – particularly in health care.India's share in global deaths, maternal and prenatal disorders, communicable disease, infant mortality and morbidity, and nutritional deficiencies, to name a few, is staggering.

I would recommend reading Abby Tabor's Blog on 

Born Too Soon: WHO says simple measures would save most premature babies


The paper titled ‘Health care and equity in India' in Lancet, by Balarajan et al. – 2011, gives a detailed account of the key challenges that the country faces with respect to health care provision, equity financing, and financial risk protection. It highlights how inequalities in socio-economic status, geography, and gender are intertwined with poor health metrics in India, using the three National Family Health Survey (NFHS) data.


Sunday 1 April 2012

mHealth India Plans 2012


Mobile Health is going to be a 3000 crore market in India by 2017. (Source PwC). M-health (use of mobile phones) and E-health are all set to make an entry into India's primary health centres (PHCs) and sub-centres as the health ministry plans to go hi-tech. Healthcare industry is expected to show a strong growth of 23% per annum to become a US$ 77 billion industry by 2012. One of the largest sector in terms of revenue and employment has grown at 9.3% per annum between 2000-2009 with a current size at par with fastest growing developing country like China, Brazil and Mexico.Driven by various catalysts such as increasing population, rising income levels, changing demographics and illness profile with a shift from chronic to life style diseases, healthcare industry is expected to move to levels of US$ 77 billion in next 3 years. (Source: ASSOCHAM).

Empowering rural India is of utmost importance and the government needs to do so by provisioning for broadband penetration and financial inclusion. Access to quality health care is another key to achieving rural empowerment. The budget for this segment was raised marginally last year and it would be good to have an allocation for rural health care programs with provisions for technology that would help modernize this sector to expand its reach through remote healthcare solutions and telemedicine.

Furthermore, the government announced a big budget campaign 'Swabhimaan' in the budget last year to promote banking and provide services to about 20,000 villages. In order to meet this goal, the budget this year too would need to make provisions accordingly. The steering committee on health said that in the 12th plan (2012-17), all district hospitals would be linked to leading tertiary care centres through telemedicine, Skype and similar audio visual media. M-health will be used to speed up transmission of data. Disease surveillance will be put on a GIS platform.

Disease surveillance based on reporting by providers and clinical laboratories (public and private) to detect and act on disease outbreaks and epidemics would be an integral component of the system.India will also put in place a Citizen Health Information System (CHIS) - a biometric based health information system which will constantly update health record of every citizen-family. The system will incorporate registration of births, deaths and cause of death. Maternal and infant death reviews, nutrition surveillance, particularly among under-six children andwomen, service delivery in the public health system, hospital information service besides improving access of public to their own health information and medical records would be the primary function of the CHIS.

Economies of Indian states can grow 1.08 per cent faster with every 10 per cent increase in Internet and broadband connections, says a study released by Indian Council for Research on International Economic Relations (ICRIER). Consequently, for every 10 per cent increase in Internet and broadband penetration, India could potentially add USD 17 billion to the Gross Domestic Product (GDP). Also as per a report by HealthCursor, the tele-density in urban areas in India is almost 100 percent while in the rural areas, it is 37 percent. The pervasiveness of mhealth and ehealth (Commnity based broadband now available) platforms will be harnessed in the MDG and National Health plans in India.

Monday 27 February 2012

Facebook in mHealth- Games for the ailing World

Have you ever thought how can Facebook revolutionarize the way healthcare is taught, implemented and delivered in the world??

Can we use Peer Pressure to eliminate Obesity? Diabetes? High Cholesterol? For a minute, let us understand what is Facebook? 
Facebook is a great way to meet friends and keep up on what they are doing. Once you add a friend to your Facebook friend list you will always know when they are adding things to their blog or updating their profile. Users can create profiles with photos, lists of personal interests, contact information, and other personal information. Users can communicate with friends and other users through private or public messages and a chat feature. They can also create and join interest groups and "like pages, some of which are maintained by organizations as a means of advertising.

Why Facebook for mHealth? It has been found that people are looking for reliable information on healthcare products and services on the worldwide web. Google shows up millions of results but people tend to rely on peer group recommendations only. Social media is most popular amongst information seekers and Facebook was the most popular one (18%), followed by YouTube (12%), Blogs (9%), Twitter (6%). The survey was conducted on 1000 respondents. Overall, nearly a third of respondents, and 50 percent of those under the age of 35, had used social media for healthcare purposes, which can range from registering a complaint to looking up informational videos on YouTube.

What all can be done? Think of Health Maps, community building, support groups and Health games- where you can throw challenges, earn points and redeem them. Pulswatch- a start-up that has created a GPS powered wearable smart sensor that allows users to set fitness goals, track their workouts and challenge one another to one of four interactive running games which spur continued exercise. For example, the platform’s running game, Chase, pits runners against their friends to match each others’ run times, or chase them down if they get too far ahead. In addition to bragging rights, the winner of the race claims a trophy and PulsWatch points which can be used to purchase additional applications from the PulsWatch store.
How about launching a Facebook currency that is as good as money and can only be redeemed on portals like healthkart.com, Drugstore etc. for buying Healthcare related products/services?


 If you have more ideas, please write to me at drruchibhatt@gmail.com

Monday 13 February 2012

mHeath based Diabetes Management in India - Remote monitoring Tools


In the past we have read a lot of research projects that determine the outcomes based overview of Diabetes management and the use of remote monitoring tools. We have spoken to Doctors,  technologists as well as equipment manufacturers and all of these available tools represent a breakthrough for clinician/patient communication to enhance disease management and improve health outcomes.

However, for India we were yet to find out the drivers, challenges, consumer behaviour, expected adoption level and value add to the end users. Here is a recent study undertaken by HealthCursor Consulting Group India to understand the DM market better.


SURVEY questionnaire:

1. If you are given a Glucometer (blood sugar check machine) for free, will you check your blood sugar daily ?
1)      Yes
2)      No


2. Your mobile phone will automatically send this data to your Doctor. Your Doctor will then SMS, EMAIL or call you if your sugar is not in control. How much you will you easily pay for this service? (Note: the doctor will not disturb you in case of normal readings.)
1)      Rs 1000-2000/month
2)      Rs 500-900/month
3)      Rs 100-400/month



3. Will you feel more comfortable if you do not have to do your blood sugar monitoring yourself but a nurse sitting in a nearby chemist store/pharmacy does it for you? In this case you will have to step out of your house but will this give you more confidence?
1)      Yes, I will feel better if a nurse does that and I don't mind driving to the chemist store.
2)      No, I would like to do it at home myself


4. Are you using a Glucometer already? Would you mind buying a new Glucometer if that connects with your phone and transfers your data automatically to the doctor?
1)      Yes, I have a Glucometer and Yes, I will buy a new one if it is the same price as my old one but has advance features like what is mentioned above.
2)      Yes, I have a Glucometer and No, I don't want a new Glucometer.
3)      No, I don't have a Glucometer but Yes, I will buy a new one if it is the same price as the one available in the market but has advance features like what is mentioned above
4)      No, I don't have a Glucometer but I will only buy known conventional brands Glucometer and will not trust any advance ones.



5. What all a Diabetic should invest in?
1)      Glucometer
2)      Glucometer, Doctor Consultation
3)      Glucometer, Doctor Consultation, Daily Glucose monitoring and advice
4)      Glucometer, Doctor Consultation,Daily Glucose monitoring and advice, Diagnostic checkups
5)      Glucometer, Doctor Consultation, Daily Glucose monitoring and advice, Diagnostic checkups, Diet plan, Exercise plan, Lifestyle and wellness plan


SAMPLE: Volunteers from the following companies participated in this survey.



Saturday 7 January 2012

mHealth India | Press releases India

mHealth India | Press releases India
HealthCursor, a niche mhealth consulting company based out of India aimed at delivering Insight Driven Healthcare solutions while realizing the promise of a connected health future was launched today. Through HealthCursor Consulting, clients in the India, Middle East and North Africa will have access to leading experts based in the region, while also benefiting from the company's strong links with practitioner communities and regulatory bodies in developing countries. HealthCursor Consulting is launched in direct response to growing demand from clients in the region for mHealth consulting services, and is a natural complement to the Founder's expertise in Healthcare IT business management and financial services. "We are putting in a team together to innovate and deliver new value by improving health outcomes and look past standalone systems and find more ways to connect fragmented healthcare ecosystems in developing countries and support new forms of care delivery, "said Dr. Ruchi Dass, Founder of HealthCursor. "This enables unprecedented capabilities to provide the right care at the right time for a whole new breed of healthcare."
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