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Kerala Boosts Emergency Care System

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Rajeev Sadanandan, Additional Chief Secretary, Department of Health, Kerala GovernmentThe triage GO is part of the initiative to build capacity of the health staff in Government to properly triage and save lives. This initiative is going on with the support of the faculty of the Jayprakash Narayan Trauma Center in AIIMS, says Rajeev Sadanandan, Additional Chief Secretary, Department of Health, Kerala Government, in conversation with Poulami Chatterjee of Elets News Network (ENN).

Q  In a recent move, the Directorate, Health Services, Government of Kerala, introduced Triage System to revolutionise emergency medical care in the State. How will this service benefit common people?

Triage is only one of the components of the emergency care system that we are developing. The crucial part is the development of an App-based, call centre managed, evacuation system through PPP. Here an aggregator (much like UBER or OLA) engages private ambulance that satisfies basic parameters, ensures that the driver and EMT have the needed training, administers the App by which any registered person can call down an ambulance and track the GPSenabled ambulances as they move towards the spot of accident. On arrival, the EMT makes an assessment and briefs the call centre. The call centre finds the nearest empanelled hospital with the required expertise, calls up the hospital, alerts them and directs the ambulance there. The hospitals are paid the cost of treatment from a corpus by a contracted fund management agency. This fund will be recouped from the company insuring the vehicle. The triage GO you are referring to is part of the initiative to build capacity of the health staff in government to properly triage and save lives. This initiative is going on with the support of the Faculty of the Jayprakash Narayan Trauma Centre in AIIMS. The standard of training would be further raised by a state-of-the-art training and simulation centre being established with the support of the TATA Trust and the Major Trauma Centre at the Warwick Medical School. The order is an attempt at formalising the training that is going on so that it is made mandatory.

Q  Despite the government promoting deceased donor organ transplant, not much has happened towards the initiative in the State. What could be the reasons behind such a low response? What measures the State health department is taking to improve the situation in the coming days?

Kerala had started the diseased donor initiative in 2012 and had become a leading State in the percentage of RTA cases that went on to donate their organs. But the adverse publicity generated by a PIL in the Kerala High Court led to drop in donations. We have revised the guidelines to remove any misgivings and are in the process of revamping the Kerala Network for Organ Sharing. We have also issued guidelines for exchange donations. We are hopeful that this would lead to Kerala getting back to our past performance in disease donor transplantation.

Q  What ideal measures should the Central Government undertake to put a check on Non- Communicable Diseases (NCDs)? Is creating public awareness enough to bring our society to regularity?

The Central Government can hardly do anything. This has to happen at the lowest level of organisation, preferably, at the community level. Their behaviour has to change to lead to good quality diet with adequate fruit and vegetables, adequate exercise, tobacco elimination, prevention of alcohol abuse. Governments can support these to reduce the cost and increase availability of fruits and vegetables, tax tobacco and strictly enforce COTPA, promote abstinence or responsible drinking and create facilities for exercise. The Central government can use the GST mechanism to tax health harming foods (as Kerala had tried to do in the FAT TAX as part of our VAT but now lost in GST) i.e. Sugared beverages and food high on sodium and incentivise food that promote good health.

Q Under the hospital automation module of the public health department, what major initiatives are being undertaken?

The e Health project has three main components: 1. Creating Electronic Health Records for all individuals 2. Digitising hospitals processes 3. Linking them to each other so that the data in EHR is available to hospitals and the data from hospital transactions are used to update the EHR. At each level there are different modules: e.g.: The demographic module, which creates the basic data on individuals, the ANC module which tracks pregnant women, the immunisation module, the NCD module etc. These are layers created on the basic layer which is the demographic module. Data collection for the basic module has started. Others are in the pipeline. At the hospital-level, there is the queue management module (which lets you book your appointments online, registers you when you reach, directs you to the consultants in the queue and channels you in), consultation module, pharmacy module (where consultants order drugs on line, drugs are filled and inventory updated), Laboratory module (orders received and results returned online), IP module. Once the system is fully functional there would be a huge accumulation of data as well as seamless portability.

Kerala had started the diseased donor initiative in 2012 and had become a leading State in the percentage of RTA cases that went on to donate their organs

Q  Is the State Health Department using Artificial Intelligence for ensuring advanced healthcare services to citizens?

Please elaborate. As of now, we do not have anything going on in AI. But some activities are planned for the future. eHealth will generate the data that can be used in AI, when we are ready for it.

Q  What are the major challenges that the State Health Department is facing to provide the best in class solutions to the last mile?

I. Shortage of resources. Our PHC strength will be needed to be increased four-fold to meet the needs of a personalied health system. Similarly, the public health system now serves only 35 percent. So if a government paid UHC has to be provided, resources have to at least double.

II. Having proper organisation of health sector in place. Reengineering the health system with primary care teams as the basis and all higher levels as referrals. The numbers in primary care has to go up, their capacity has to increase, referral systems have to be in place. Here more than resources it is the planning capacity that is the challenge. Since no other state has done this in India we will need to get support from countries that have a functional GP system.

III. We are yet to develop a good emergency and trauma care system, even though efforts are on.

IV. Emergence of Antimicrobial resistance is forcing us to rethink the way we practice medicine. Soon, in almost every case we will have to test drug sensitivity and modulate our antibiotics accordingly. This is a major shift in our hospital practices.

V. Engaging the private sector in good public health practices. VI. We are committed to eliminate Malaria, Filariasis and Leprosy by 2020 and TB by 2025. Since India would not have reached there by this time, we have to move for sub-national certification of elimination to confirm success. This is an arduous process.

VI. We are committed to eliminate Malaria, Filariasis and Leprosy by 2020 and TB by 2025. Since India would not have reached there by this time, we have to move for sub-national certification of elimination to confirm success. This is an arduous process.

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