Trends

1
TRENDS AND ISSUES IN MED SURG OVERALL SCENARIO
IN INDIA
2
Who were..

• THE FIRST
• NURSES?

3

• PRE HISTORIC PERIOD
• GOD,EVIL ,SIN CAUSE DISEASE
• MAKING HOLES IN BODY TO WARD OFF DISEASE
• MIDDLE AGE
• care was provided primarily by religious orders
  , mainly by nun sisters

4
NURSING AS A PROFESSION

• Emerged in late 19th century
• Credit is given to Florence Nightingale

5

• IN INDIA
• KING ASHOKA, CHARAKA,SUSRUTHA ARE IMPORTANT
  PERSONS
• EAST INDIA COMPANY INTRODUCED NURSING
• JAMSHETJEEJEE JEEBHOY WAS THE FIRST TRAINED NURSE

6
CURRENT HEALTH STATUS
7
TOP CAUSE OF DEATH IN INDIA
CAUSE DEATH/ 1OOO
IHD 15
LRTI 11
CEREBRO VASCULAR DISEASE 106
COPD 88
TUBERCULOSIS 36
DIARRHOEAL DISEASE 65
HIV/AIDS 46
W H O(2008)
8
DISEASE WISE POPULATION IN INDIA
DISEASE POPULATION
COPD ASTHMA 4.6 MILLION
DIABETIC 3.5 MILLION
HIV POSITIVE 2-3 MILLION
EPILEPTIC 0.5 MILLION
CANCER 1 MILLION
CARDIO VASCULAR 3.3 MILLION
MENTAL HEALTH 7.5 MILLION
TUBERCULOSIS 1.8 MILLION
BLINDNESS 16 MILLION (11TH FIVE YEAR PLAN )
9
MEDICAL AND NURSING STUDIES CONDUCTED IN
INDIA

• (CLINICALTRIAL.GOV 2008)

NO OF RESEARCH STUDIES CNS COPD CVD CANCER Tb DM HIV PSYCHIATRY
591 51 10 149 166 14 115 40 46
10
TRENDS
11
HEALTHCARE INDIA

• Beds 0.7/1000 people
• Extra Beds needed 75000 beds / per year
• Expected spend on Rs.2000 billion by 2012
  Healthcare
• of GDP 0.9 to grow
  up to 8.5 of GDP
• Govt. Spend expected up 6 by 2010
• GDP- sum of the income generated by production in
  the country in a period

12
TECHNOLOGY - TRENDS(Healthcare will be the
largest user of technology and the largest
Employer)

• Micro-processor based implantable in patients.
• CPU-driven technology supported by artificial
  intelligence.
• Robotics in OTs
• Robotics in Path-labs / Research.
• Laser Technology in surgery
• Instrumentation in medical and surgical
  practices.
• Biotechnology, Genomics, Molecular Biology and
  Stem cell research.

13
ReMeDi Telemedicine solution

• Video conferencing over very low bandwidth
  Video audio data transmission at 28 Kbps
• Equipment taking rural conditions into account
  completely battery operated, reengineering of
  probes, wireless connectivity with the PC
• Breaking of the cost barrier while maintaining
  the quality entire telemedicine solution at
  affordable prices
• No additional software or hardware needed other
  than PC, web cam, internet connectivity

• ReMeDi Remote Medical Diagnostics
• Medical equipment
• 12 channel ECG, Blood pressure, Heart sounds,
  Pulse rate, Temperature, Pulseoximeter, Image
  capture,
• Video and audio conferencing, Data presentation
  and display, Electronic patient records
  accessible at any time, print facility

14
Tele-medicine cluster for villages
Telemed Solution
Telemed Solution
Telemed Solution
Telemed Solution
Healthcare can reach every village with
Tele-medicine
15

• ISSUES

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Limits to Modern Medicine
Spectacular Advances Low Cost Nutrition, Immunization, Antibiotics, Aseptic surgery, Maternal and child care, Healthy life styles
Grey Areas High Cost Degenerative diseases, Autoimmune diseases, Malignancies
Dark Areas Idiopathic, Iatrogenic, Hospital Infections, Progressive, irreversible disorders
17
Hospitalization Financial Stress

• Only 10 Indians have some form of health
  insurance, mostly inadequate
• Hospitalized Indians spend 58 of their total
  annual expenditure on health care
• Over 25 of hospitalized Indians fall below
  poverty line because of hospital expenses

18
Percent of Hospitalized Indians falling into
Poverty
19
Differentials in Health Status (States)
Sector Population BPL () Population BPL () IMR/ Per 1000 Livr Births (1999 SRS) lt5Mortality per 1000 (NFHS II) Weight For Age - of Children Under 3 years (,2SD) MMR / Lakh (Annual Report 2000) Leprosy cases per 10000 population Malaria ve Cases in year 2000 (in thousands)
India 26.1 26.1 70 94.9 47 408 3.7 2200
Rural 27.09 27.09 75 103.7 49.6 - - -
Urban 23.62 23.62 44 63.1 38.4 - - -
Better Performing States Better Performing States Better Performing States Better Performing States Better Performing States Better Performing States Better Performing States Better Performing States
Kerala Kerala 12.72 14 18.8 27 87 0.9 5.1
Maharashtra Maharashtra 25.02 48 58.1 50 135 3.1 138
Tamil Nadu Tamil Nadu 21.12 52 63.3 37 79 4.1 56
Low Performing States Low Performing States Low Performing States Low Performing States Low Performing States Low Performing States Low Performing States Low Performing States Low Performing States
Orissa Orissa 47.15 97 104.4 54 498 7.05 483
Bihar Bihar 42.60 63 105.1 54 707 11.83 132
Rajasthan Rajasthan 15.28 81 114.9 51 607 0.8 53
UP UP 31.15 84 122.5 52 707 4.3 99
MP MP 37.43 90 137.6 55 498 3.83 528
Source National Health Policy, 2002 Source National Health Policy, 2002 Source National Health Policy, 2002 Source National Health Policy, 2002 Source National Health Policy, 2002 Source National Health Policy, 2002 Source National Health Policy, 2002 Source National Health Policy, 2002 Source National Health Policy, 2002
20
SCENARIO
21
Over the past years, we had set a bold aspiration
for health in India
India was a signatory to the Alma-Ata declaration
1978, to attain the global objective of Health
for All by year 2000 now Health for all
by the year 2020
Escorts Heart Institute Research Centre Ltd,
New Delhi, INDIA
22
But we are far from achieving that vision

• Beds

• Physicians

• Nurses

• Per 000 population, 2001

• Per 000 population, 2001

• Per 000 population, 2001

0.5
1.2

• India

0.9
1.5

• Other low income countries (e.g., sub-Saharan
  Africa)

1.5
1.6
1.0

• Middle income countries (e.g., China, Brazil
  Thailand, South Africa, Korea)

4.3
1.8
1.9

• High income countries (e.g., US, Western Europe,
  Japan)

7.4
1.8
7.5

• World average

Escorts Heart Institute Research Centre Ltd,
New Delhi, INDIA
23
NATIONAL SAMPLE SURVEY

• Demographic Facts Longevity
• Life Expectancy (years)
• Year AGE
• 1941-50 32.1
• 1951-60 41.2
• 1991-95 60.3
• 1996-2001 62.88
• 2001-2006 64.77
• 2006-2011 66.43

24
INDIAN HEALTHCARE CAPABILITY

• Over 60,000 cardiac surgeries done per year with
  out comes at par with international standards
• Multi organ transplants like Renal, Liver, Heart,
  Bone Marrow Transplants, are successfully
  performed at one tenth the cost.
• Patients from over 55 countries treated at Indian
  Hospitals.

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INDIAN HOSPITALS CAN OFFER MEDICAL SERVICES AT A
FRACTION OF THE US / EUROPEAN COST
PROCEDURE
COST (US)
US
UK
INDIA
THAILAND
7,500 ------- ------- 8,000 3,500
6,000 26,000 69,000 6,000 2,000
23,000 1,50,000 2,00,000 12,000 10,000
40,000 2,50,000 3,00,000 20,000 20,000
Heart Surgery Bone Marrow Transplant Liver
Transplant Knee Replacement Cosmetic Surgery
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India has the opportunity to provide the best of
the Western Eastern healthcare systems
Indias Gift to the World

• Ayurveda recognized as an official healthcare
  system in Hungary.
• Doctors in the west are increasingly prescribing
  Indian Systems of Medicine
• More than 70 of the American population prefer a
  natural approach to health
• Americans are said to spend around 25bn on
  non-traditional medical therapies and products

Ayurveda Yoga Siddha
Source Los Angeles Times Economic times
dated 25th July 2003
Escorts Heart Institute Research Centre Ltd,
New Delhi, INDIA
27
(No Transcript)
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•           The Gamma Knife isn't really a knife
  at all, but radio surgery - a non-invasive
  neurosurgical procedure that uses powerful doses
  of radiation to target and treat diseased brain
  tissue while leaving surrounding tissue intact.
• Gamma Knife surgery represents one of the most
  advanced means available to manage brain tumours
  , arteriovenous malformations , pain or movement
  disorders.
• The procedure is unique because, with the Gamma
  Knife, no surgical incision is performed to
  expose the target.

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1) THERA SPHERE THERAPY IN LIVER TUMOUR
2) CYBER KNIFE STEREOTACTIC RADIOSURGERY
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CONCLUSION
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Challenges of the Future

• Immunization coverage ( TB 68, Measles 50,
  DPT 70, overall 33)
• Four major infectious diseases Malaria, TB,
  HIV/AIDS, RHD
• Preventable blindness
• Population control large northern state
• Alternative systems integration
• Mounting cost of hospital care
• Health manpower training inadequacies

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Healthcare Infrastructure.. In Summation

• India needs at least 750,000 extra beds to meet
  the demand for inpatient treatment by 2012-
  opportunity in tertiary healthcare facilities.
• India needs at least 1 million more qualified
  nurses and 500,000 more doctors by 2012 as
  compared to existing number.- opportunity in
  medical education.
• Government and international agencies will only
  be able to gear up US 7 billion and the rest of
  investment has to come from private sector.

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• Politics encircles us today like the coil of a
  snake from which one cannot get out, no matter
  how much one tries
• - Mahatma Gandhi