Dr. Kishore Kumar, Founder & Chairman, Cloudnine Group of Hospitals
You have worked extensively in the field of maternal/fetal and neonatal care. What do you think are the most significant changes in this sector of healthcare?
It’s good that maternal, fetal and neonatal health is being discussed. These areas have been neglected for a long time in India. Countries like UK, Europe and USA have reduced their quality indices and progressed; the Quality Indices of maternal, fetal and neonatal health are measured by their mortality rates. In the last 10 years, the focus has shifted to these issues due to various govt programmes like Pradhan Mantri Surakshith Matritva Abhiyan, Rashitriya Kishor Swasthya Karyakaram, Lakshya in addition to periodic maternal death surveillance reports – these have impacted the sector in a big way. There’s a rapid decline in mortality rates but we still have a long way to go to reach standards seen currently in developed nations. The other thing we’re seeing is the discrepancy of healthcare between states in India – For instance, take Kerala where the Maternal Mortality Rate is as good as USA, but Haryana’s numbers are as bad as that of some African nations.
How does India currently fare in ensuring expectant mothers and newborns are given continuum of care?
Currently, standards of care are grossly different across states. The state-wise burden is more focused now than it was in the past. In May 2017, the Govt of India introduced the pneumococcal vaccine to four North-Western states in India, where the incidents of death due to pneumonia was the highest in the country. Moreover, this vaccine has shown to reduce deaths caused by pneumonia world over. So on an experimental basis in May 2017, this vaccine was introduced in the four states and results are expected anytime soon. As such steps are taken with a focus on targeted areas and states, health indices will improve. Healthcare standards across the country is patchy – some states are excellent, some are poor. We need to learn from the ones doing well, and scope out areas of collaboration.
What steps are being taken by Cloudnine Group of Hospitals to elevate policy intervention in healthcare?
We’re a young company – just 13 years old! When we started, no one believed maternal and neonatal care can make a difference. We believed in our thought process and quality care. What we accomplished in one centre, we replicated the same across 20 centres. Now we can proudly say we have 0% mortality rate and 99.3% survival of babies across all our centres. Standards are living proof of our accomplishments. In order to replicate such results in the public sector, we have initiated the process.. We have participated in several public programmes, initiated accredited programmes for breastfeeding for many industries, lactation support for PHCs, and have extended support to charitable organization by providing doctors in health camps. We also launched the Cloudnine Foundation to execute these activities in an organised manner. We have even extended our expertise to the government to do public-private partnerships and initiated electronic and central NICU and tele-NICU programmes – a hub-&-spoke model for neonatal healthcare, connected by wireless and bluetooth technologies.
The NDHB is one of the biggest developments in the space of healthcare policy, especially since it relies heavily on industry counsel – your thoughts on how this is helping the ecosystem.
The NDHB can lead to revolutionary changes in healthcare, if implemented properly. We have been digitising outpatient and inpatient records for 13 years. We have achieved a milestone with all doctors using digital records only in the past year or so. Denmark has had data analytics in health for 60 years, even before computers became popular. Based on their data aggregation and analytics, they identified several years ago that thalidomide caused limb abnormalities. Collection of patient data is very important – without data, analytics won’t happen; without analytics, healthcare standards won’t improve. Hopefully, a country like India where 26 million babies are born every year, we should be the leaders in developing a healthcare policy in maternal and neonatal care.
Maternal & fetal healthcare in rural areas still remains a major opportunity for big players from various levels ranging from tech, to policy to end-to-end delivery. How is Cloudnine Group of Hospitals capitalising on this?
There is a visible discrepancy in standards of healthcare in rural and urban areas of India. There are various issues – namely challenges in transportation & connectivity, quality of care and investment in infrastructure to name a few. For instance, if you drive 100 km from Bangalore, you will not find a doctor who can do a lung function test for an adult suffering from asthma. If there’s no equipment for a commonly prevalent diseases like asthma, it is hard to expect investments in niche equipment needed for maternal & foetal care. Super-speciaists required to do quality care prefer to live in urban areas so the only way healthcare in rural areas can improve is by doing tele-health and implement hub-and-spoke models. Otherwise, rural and urban challenges remain isolated. We are establishing tele NICUs with the hope of providing a hub-and-spoke model for specialised nenonatal care. Even after this, if a patient needs specialist care, they can be brought to regional centres.
Several healthcare startups in India seem to specifically gravitate towards addressing rural healthcare issues, but often run into roadblocks when they have to scale/expand. What can be done by major hospital chains like you to give them the assistance they need?
We are one of the few hospitals chains that has consistently encouraged clinical research. 11 years ago, there was a company called Embrace Innovations that created a low-cost baby warmer. We were the first chain of hospitals to do a pilot study with them. They have gone on to win several awards for their innovation. As a shoot off of this pilot, we published our study in the British Journal of Archives of Disease in Childhood. Last year, we did a pilot on remote monitoring devices, made by a company in Chennai. It can measure a baby’s heart rate, respiratory rate and temperature, mitigating the need for a nurse having to constantly check a baby’s vitals and doctors can directly check the mobile app for data. That company is now commercially producing their medical equipment. We’re doing three more trials on medical equipment made by startups, which include remote monitoring of pregnant women at home through mobile apps or bluetooth. We have another equipment, which can do photo-therapy for mothers at home instead of them having to come to the hospital after childbirth.
What do you think is the future of healthcare policy development in India – do you believe this is a mature enough market?
India is a mature market. If you look at the global market, only UK and Canada are providing healthcare to the entire country, and they are also struggling. Costs are rising especially for geriatric and oncology care. What we need is a combination of private and public healthcare – something like Australia, which has the right balance – here, the rich can pay for private healthcare and the poor can be given subsidised yet quality treatment. We have a lot to achieve if we need to attain good standards of healthcare in India, where 35% are under age 35. Over the next 10-15 years, costs are going to rise. We have started thinking about it, and we need to invest in our future.
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