Aseem Garg, Founder and CEO, DCDC talks about dialysis care and highlights that one of the biggest issues is of last-mile delivery and ramping up dialysis centres in the country
With a population of 1.3 billion, India has a peculiar dual disease burden, which means a rise in both communicable diseases that are the bane of the developing world, like malaria/dengue, and non-communicable diseases (NCDs) like cancer, diabetes, heart ailment and kidney disease. Since the government acts swiftly to contain communicable diseases to prevent their vast spread and funds get diverted towards those, lifestyle diseases or NCDs end up growing faster in numbers.
As per a study in 2016, “Health of the Nation’s States: India State-Level Disease Burden”, NCDs accounted for nearly 61.8 per cent of the total deaths, while communicable, maternal, and nutritional diseases caused 27.5 per cent of deaths. The study pointed out that the prevalence of NCDs is seen more in affluent states such as Tamil Nadu, Kerala, Punjab and Goa. A recent study by India Brand Equity Foundation (IBEF) too corroborates that 50 per cent of spending on in-patient beds is for NCDs, and this has increased the demand for specialized care. Often NCDs result in early deaths, impact work and family life, and cause huge financial upheavals, depressing the growth of the economy. A majority of the deaths in the developing world, including India, occur at home, and about half are not assigned a certified cause. So, the exact latest figures are hard to find, but as per a study, there has been a steady increase in kidney illness-related fatalities in the country, and a 38 per cent rise in such fatalities was reported between 2001-03 and 2010-13. Therefore, it’s important to think of novel approaches to boost infrastructure and other support needed to deal with the illness that so far, cannot be cured, but can only be managed.
Last mile delivery
One of the biggest issues is of last-mile delivery and ramping up dialysis centres in the country. There are approximately 4,950 dialysis centres, managed largely by the private sector, and located in urban centres mostly–a trend that shows a Bharat-India divide in healthcare delivery. Two-thirds of the population of India live in rural areas, where the availability of hemodialysis is limited. According to studies, nearly 60 per cent of patients on dialysis travel more than 50 kms to access dialysis. The burden of travel increases costs and impacts work productivity. Further, women are under-represented, and there are few pediatric dialysis services. Moreover, India has one of the lowest nephrology workforce densities worldwide. There are only about 2,600 nephrologists (1.9 per million population), and there is a chronic shortage of dialysis centres, nurses and technicians.
The National Library of Medicine, a global healthcare resource, mentions that the dialysis area should be air-conditioned so as to achieve 70°F–72°F temperatures and 55 per cent–60 per cent humidity, and each machine should be placed to allow easy movement of personnel and resuscitation equipment whenever needed. The layout should have facilities for protecting patient’s privacy, nursing counters, isolation rooms for Hepatitis B and Hepatitis C patients, and so on.
Availability of nephrologists and proximity to multi-specialty hospitals are other parameters to consider as patients are usually in a fragile state of health and the likelihood of any life-threatening emergency arising anytime with kidney patients has to be addressed. As per the American Society of Nephrology (ASN), the Indian dialysis market is estimated to be growing at a rate of 31 per cent per annum, compared with 8 per cent in the rest of the world. Huge opportunity exists in providing reliable dialysis services for all, and in ensuring better accessibility.
To bridge the infrastructure gap, the government is encouraging new business models under Public-Private-Partnership (PPP). The Pradhan Mantri National Dialysis Programme was rolled out in 2016 as part of the National Health Mission (NHM) to provide free dialysis services to the poor. The program envisages dialysis services in the states, beginning with the District Hospitals in a PPP mode. A dialysis centre should provide medical teams, dialysis machines along with RO water plant infrastructure, dialyzer and consumables, while the government makes available space in District Hospitals, drugs, power and water supply and pays for the cost of dialysis of poor patients.
Even as more reliable centres open up increasing reach and accessibility for all, awareness programs can help alert people towards early signals of the disease so that it does not progress too fast. End-stage renal disease (ESRD)–the sixth fastest-growing cause of death worldwide is the result of several lifestyle ailments like diabetes and blood pressure. Among others, obesity, blood pressure and sugar levels can be monitored early on so that they do not lead to organ failure. The government programs like Fit India and Yoga Day encourage greater awareness to keep diseases in check.
Kidney disease is a silent killer and patients should be watchful of symptoms like swollen ankles and feet, shortness of breath, increased urination, insomnia, among others. Every year about 2.2 lakh new ESRD patients get added in India resulting in additional demand for 3.4 crore dialysis every year. High costs of dialysis topple the finances of most families with such patients. Though the Organ Transplant Bill was passed in India in 1994, organ donation rate in India is 0.01 per cent which makes renal replacement therapy beyond the reach of most people and dialysis remains the only way to prolong life. Therefore, accessibility to reliable dialysis centres and awareness programs for early detection of kidney disease will help to lessen the disease burden.
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