Recent advances in the diagnosis and treatment of childhood tuberculosis.

Despite over 2.3 million (26% of global burden) cases of tuberculosis (TB) in India the accurate diagnosis of childhood TB remains a major challenge. Children with TB usually have paucibacillary disease and contribute little to disease transmission within the community. Consequently the treatment of children with TB is often not considered a priority by TB control programmes. Adequate and timely assessment of TB infection in childhood could diminish epidemiological burden as under diagnosed paediatric patients can eventually evolve in to an active state and have the potential to disseminate the etiological agent Mycobacterium tuberculosis, notably increasing this worldwide public health problem. In this review we discuss the most important recent advances in the diagnosis of childhood TB: (1) Symptom-based approaches, (2) novel immune-based approaches, including in vitro interferon-γ IGRA release assays IGRA tests; and (3) bacteriological and molecular methods that are more rapid and/or less expensive than conventional culture techniques for TB diagnosis and/or drug-resistance testing. Recent advances have improved our ability to diagnose latent infection and active TB in children, nevertheless establishing a diagnosis of either latent infection or active disease in HIV-infected children remains a major challenge.

Recent advances in the diagnosis and treatment of niemann-pick disease type C in children: a guide to early diagnosis for the general paediatrician.

Niemann-Pick disease (NP-C) is a lysosomal storage disease in which impaired intracellular lipid transport leads to accumulation of cholesterol and glycosphingolipids in various neurovisceral tissues. It is an autosomal recessive disorder, caused by mutations in the NPC1 or NPC2 genes. The clinical spectrum is grouped by the age of onset and onset of neurological manifestation: pre/perinatal; early infantile; late infantile; and juvenile periods. The NP-C Suspicion Index (SI) screening tool was developed to identify suspected patients with this disease. It is especially good at recognizing the disease in patients older than four years of age. Biochemical tests involving genetic markers and Filipin staining of skin fibroblast are being employed to assist diagnosis. Therapy is mostly supportive and since 2009, the first specific therapy approved for use was Miglustat (Zavesca) aimed at stabilizing the rate of progression of neurological manifestation. The prognosis correlates with age at onset of neurological signs; patients with early onset form progress faster. The NP-C disease has heterogeneous neurovisceral manifestations. A SI is a screening tool that helps in diagnostic process. Filipin staining test is a specific biomarker diagnostic test. Miglustat is the first disease-specific therapy.

Recent Advances in the Diagnosis and Treatment of Viral Diseases of the Skin

THE past decade has seen remarkable progress in knowledge of viruses pathogenic to man. Largely through the development of in vitro cell-culture techniques it is now possible to propagate in the laboratory many viruses whose existence had been assumed because of the diseases that they produce — for example, measles, German measles, chicken pox. Adenoviruses and common-cold viruses. In addition, the same techniques have allowed the isolation of a number of agents, previously unknown, for which diseases in human beings have been sought: ECHO (enteric cytopathic human orphan) viruses and reoviruses are examples. Skin manifestations of viral infections have always...

Recent Advances in Diagnosis and Treatment for Esophageal Cancer – From Early to Advanced Cancers (Core Symposium 1 at the 7th Annual Meeting of JGA)

Esophagectomy is a surgery involving a lot of surgical stress. Therefore, a demand for non-surgical management of superficial esophageal cancer is increasing. Yamada et al. from Osaka University demonstrated results of their basic strategy; endoscopic mucosal resection (EMR)/endoscopic submucosal dissection (ESD) for mucosal cancer and chemo radiotherapy (CRT) for sub mucosal cancer. They revealed that survival after EMR/ESD for T1a cancer was excellent and prognosis after CRT for T1b was comparable to esophagectomy. Iizuka et al. from Toranomon Hospital demonstrated their own results of ESD for superficial esophageal cancer invading into the muscularis mucosa without nodal involvement. They decided the necessity of additional treatment strategy based on the pathologic results of ESD. As ESD followed by surgery or CRT can be performed safely and long-term survival of these patients was favorable, their strategy seemed to be feasible. Yamaguchi et al. from Nagasaki University presented the efficacy of ESD and photodynamic therapy. They demonstrated that a prophylactic oral steroid significantly reduced the stenosis after ESD for lesions more than 3/4 circumferences. They also demonstrated photodynamic therapy as a useful alternative for local recurrence after CRT.

Yamamoto et al. from Osaka Medical Centre for Cancer and Cardiovascular Diseases retrospectively analyzed prognoses of stage I disease treated either by surgery or CRT, and demonstrated that the long-term survival of patients treated by CRT was comparable with those treated by surgery. They concluded that CRT can be an alternative for esophagectomy in stage I esophageal cancer.

Less invasive surgery is another approach to reduce the surgical risk. Matsumoto et al. from Kawasaki Medical School demonstrated results of transhiatal esophagectomy for superficial esophageal cancer or advanced lower esophageal cancer. They concluded that the less invasive surgery can be indicated for selected patients.

Prediction of therapeutic response is a matter of the greatest importance. Watanabe et al. from Kumamoto University reported the correlation between micro RNA expression in the pre treatment biopsy samples and response to induction DCF. Akutsu et al. from Chiba University demonstrated that high COX2 expression in the pre treatment biopsy samples can be a biomarker for resistance to CRT. Minashi et al. from National Cancer Centre East Hospital demonstrated an efficacy of gene profiling in predicting prognosis of patients with stage II/III esophageal cancer treated by CRT. These efforts might enable tailor-made treatment for esophageal cancer in the near future.

Alteration of chemotherapeutic regimen is another approach to improve the response to CRT. Kimura et al. from Tokushima University reported the results of CRT with a novel regimen consisted of irradiation combined with 5-FU/nedaplatin and indicated that this regimen may improve the survival. Large-scale trials are needed to establish the more efficient drug combination.

Salvage esophagectomy is an effective treatment for patients with remnant or recurrent diseases after definitive chemo radiotherapy, although high morbidity and mortality has been reported. Takemura et al. from Hyogo College of Medicine demonstrated their own experiences on salvage esophagectomy. They could prevent hospital mortality by limiting the lymph node dissection. They also revealed that the long-term survival depended on the stage before CRT.


The contents of these two core symposia illustrated two directions in the management of gastrointestinal malignancies, one of which is a less invasive treatment for early diseases and another is a multimodal treatment strategy for advanced or metastatic diseases. Although there were few debates on the advances in diagnosis of gastrointestinal tumours in these symposia, an accurate diagnosis is essential for making appropriate treatment strategy. Progress in the diagnosis, such as recent endoscopic technology for accurate diagnosis of early cancers and usefulness of positron emission tomography for advanced cancers will be discussed in the future symposium.

ESD has become one of the major treatment modalities for early gastrointestinal cancers. Efforts to extend the indication are in progress and will be good news for patients. CRT is not only a less invasive treatment but also contributes to organ preservation. However, the outcome of patient’s refractory to CRT is pessimistic. Therefore, predictive parameters for the effect of CRT should be established, while safety of salvage treatment should be assured. As a less invasive treatment, significance of minimally invasive surgery, including laparoscopic or thoracoscopic surgery, should be clarified in a future symposium.

In Japan the surgeon’s efforts have been focused on complete removal of regional lymph nodes. D2 dissection for gastric cancer has been proven to have survival benefit in a long-term follow-up of a Dutch trial. Similarly, the number of dissected lymph nodes has been reported to correlate with the prognosis of colon cancer. These findings indicate that lymph node dissection contributes to prolonged survival. On the other hand, several randomized control trials which compared prognosis of patients between standard and extended lymphadenectomy failed to demonstrate the survival benefit, suggesting that the effect of lymph node dissection is limited. Adjuvant chemotherapy might be promising to overcome the limitation.

The effect of adjuvant chemotherapy has already been proven in gastric, colon and pancreatic cancers. In esophageal cancer the survival benefit of neoadjuvant chemotherapy compared to adjuvant chemotherapy has been proven in Japanese patients. Benefits of neoadjuvant chemotherapy compared to adjuvant chemotherapy include good compliance for the treatment and increased curability in surgery. However, there is a risk to disease progression in cases refractory to chemotherapy. Therefore, biomarkers to predict response to chemotherapy are needed to decide on an appropriate treatment strategy for each patient.


Less invasiveness and multidisciplinary approach are the two major key words for the management of gastrointestinal malignancies. Efforts in translational research as well as in clinical studies will deliver less invasive and more effective treatment for gastrointestinal cancers.

Recent Advances in Diagnosis and Treatment for Malignancies of the Gastrointestinal Tract

Recent advances in diagnostic imaging have made it possible to detect early cancers in the gastrointestinal tract, while the development of novel antitumor agents has contributed to improved survival of patients with advanced cancers. In this review, the contents of the core symposia on ‘Recent Advances in Diagnosis and Treatment for Malignancies of the Gastrointestinal Tract’, held at the 6th and 7th annual meeting of The Japanese Gastroenterological Association, are summarized. At the 6th annual meeting the core symposium focused on ‘Progress in Chemotherapy and Targeted Therapy for Gastrointestinal Malignancies’. On the other hand, the 7th annual meeting focused on ‘Recent Advances in Diagnosis and Treatment for Esophageal Cancer’. Less invasiveness and multidisciplinary approach are the two major key words in the management of gastrointestinal malignancies. Efforts in translational research as well as in clinical studies will deliver less invasive and more effective treatment for gastrointestinal cancers.


The Japanese Gastroenterological Association (JGA) organizes core symposia at the annual scientific meetings in order to enable continuous discussion on several important topics. One of the topics is ‘Recent Advances in Diagnosis and Treatment for Malignancies of the Gastrointestinal Tract’. Recent advances in diagnostic imaging have made it possible to detect early cancers in the gastrointestinal tract, which could be cured by less invasive treatment. On the other hand, owing to development of novel antitumor agents, prognosis of patients with advanced or metastatic cancers is getting better. In this review the contents of the core symposia are briefly summarized.

Progress in Chemotherapy and Targeted Therapy for Gastrointestinal Malignancies (Core Symposium 1 at the 6th Annual Meeting of JGA)

A recent trend in Japan for resectable stage II/III esophageal squamous cell cancer is neoadjuvant chemotherapy followed by surgery. From Kumamoto University treated node-positive esophageal cancer with two courses of modified DCF (docetaxel, cisplatin and 5-fluorouracil) regimen as neoadjuvant or induction chemotherapy, and demonstrated an excellent treatment effect and sufficient downstaging. Induction chemotherapy is defined as the use of drug therapy as the initial treatment for patients presenting with advanced cancer that cannot be treated by other means. In order to improve the survival of esophageal cancer, establishment of multimodal treatment strategy, especially of neoadjuvant treatment, is essential.

Two important topics on chemotherapy for gastric cancer were adjuvant chemotherapy for resectable cancers and a new regimen for peritoneal dissemination. Emi et al. from Kyushu University demonstrated the strategy of clinical trials on the adjuvant and neoadjuvant chemotherapy, using S-1 plus docetaxel. They suggested that the poor compliance due to postoperative morbidity or disorders might be a major problem in the adjuvant chemotherapy. An efficacy of neoadjuvant chemotherapy for advanced cancer will be clarified in the near future. Ishigami et al. from Tokyo University reported a phase II trial of oral S-1 plus intraperitoneal paclitaxel for peritoneal metastases. They treated 18 patients and the response rate was 56% (95% CI 32–79). Sixteen gastrectomies, including 13 curative resections, were carried out. Large-scale trials on such an effective regimen are expected to clarify the efficacy.

Recent advances in chemotherapy for colorectal cancer have improved the survival of unresectable or metastatic cases. As the response to chemotherapy varies among individuals, response predictors would be helpful to decide on a personalized treatment strategy. Ishizuka et al. from Dokkyo University investigated the possibility of Glasgow prognostic score in predicting response to FOLFILI or FOLFOX4, and demonstrated that the Glasgow prognostic score was a significant prognostic factor by multivariate analysis. Furukawa et al. from KKR Sapporo Medical Centre demonstrated that skin toxicity was a predictive marker for response to cetuximab in Japanese patients as well as in Western countries.

Targeted therapy has become one of the key modalities for colorectal cancer. EGFR-KRAS signalling is especially a major target. Sugimoto et al. from Osaka Medical Centre for Cancer and Cardiovascular Diseases investigated the efficacy of cetuximab in Japanese patients with K-ras wild-type advanced or metastatic colorectal cancer, and revealed that the efficacy of cetuximab in Japanese patients was comparable to those reported in the Western countries. Kimura et al. from Tokushima University reported the significance of a high sensitivity analysis of KRAS and BRAF in predicting the response to cetuximab. The two-step PCR-RFLP method increased the detection rate of both KRAS and BRAF mutations, and thus may help in selecting patients who benefit from cetuximab.

Rapid progress has also been observed in the strategy for colorectal liver metastasis. Sato et al. from Kitazato University demonstrated the improved survival after the introduction of FOLFOX. They demonstrated that neoadjuvant chemotherapy using recent new drug regimens may improve the survival of colorectal liver metastasis, although a further large-scale analysis is needed.

15 Healthcare schemes in India that you must know about

Health is a fundamental human right and a global social goal. It is pertinent for the realization of basic human needs and for a better quality of life.

Health is a causative factor that affects country’s aggregate level of economic growth. Since development is a consequence of good health, even the poorest developing countries should make it a priority to invest in the health sector. Unfortunately, health has been poorly invested in by countries with low human development, and the health sector still remains largely untapped and continues to suffer neglect.

Where does India stand?

India’s rank in the Human Development Index Report 2018 (130 out of 189 countries) issued by the UNDP depicts the level of ignorance of the health sector in a country like India.

India is one of the fastest growing economies of the world. The very essential components of primary health care– promotion of food supply, proper nutrition, safe water and basic sanitation and provision for quality health information concerning the prevailing health problems – is largely ignored. Access to healthcare services, provision of essential medicines and scarcity of doctors are other bottlenecks in the primary health care scenario.

Healthcare schemes in India you must know about

Under the National Health Mission, the government has launched several schemes like:

1. Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCH+A) programme essentially looks to address the major causes of mortality among women and children as well as the delays in accessing and utilizing health care and services. It also introduces new initiatives like the use of Score Card to track health performance, National Iron + Initiative to address the issue of anaemia across all age groups and the Comprehensive Screening and Early interventions for defects at birth, diseases, and deficiencies among children and adolescents.

2. Rashtriya Bal Swasthya Karyakram (RBSK) is an important initiative aiming at early identification and early intervention for children from birth to 18 years to cover 4 ‘D’s viz. Defects at birth, Deficiencies, Diseases, Development delays including disability. Early detection and management diseases including deficiencies bring added value in preventing these conditions to progress to its more severe and debilitating form

3. The Rashtriya Kishor Swasthya Karyakram The key principle of this programme is adolescent participation and leadership, Equity and inclusion, Gender Equity and strategic partnerships with other sectors and stakeholders. The programme enables all adolescents in India to realize their full potential by making informed and responsible decisions related to their health and well-being and by accessing the services and support they need to do so.

4. The government of India has launched Janani Shishu Suraksha Karyakaram to motivate those who still choose to deliver at their homes to opt for institutional deliveries. It is an initiative with a hope that states would come forward and ensure that benefits under JSSK would reach every needy pregnant woman coming to government institutional facility.

  • Since the rate of deaths in the country because of communicable and non-communicable diseases is increasing at an alarming rate, the government has introduced various programmes to aid people against these diseases.
  • In India, approximately about 5.8 million people die because of Diabetes, heart attack, cancer etc each year. In other words, out of every 4 Indians, 1 has a risk of dying because of a Non- Communicable disease before the age of 70.
  • According to the World Health Organisation, 1.7 million Indian deaths are caused by heart diseases.

5. National AIDS Control Organisation was set up so that every person living with HIV has access to quality care and is treated with dignity. By fostering close collaboration with NGOs, women’s self-help groups, faith-based organizations, positive people’s networks, and communities, NACO hopes to improve access and accountability of the services. It stands committed to building an enabling environment wherein those infected and affected by HIV play a central role in all responses to the epidemic – at state, district and grassroots level.

6. Revised National TB Control Programme is a state-run tuberculosis control initiative of Government of India with a vision of achieving a TB free India. The program provides, various free of cost, quality tuberculosis diagnosis and treatment services across the country through the government health system.

7. National Leprosy Eradication Programme was initiated by the government for Early detection through active surveillance by the trained health workers and to provide Appropriate medical rehabilitation and leprosy ulcer care services.

8. The Government of India has launched Mission Indradhanush with the aim of improving coverage of immunization in the country. It aims to achieve at least 90 percent immunization coverage by December 2018 which will cover unvaccinated and partially vaccinated children in rural and urban areas of India.

9. In order to address the huge burden of mental disorders and the shortage of qualified professionals in the field of mental health, Government of India has implemented National Mental Health Program to ensure the availability and accessibility of minimum mental healthcare for all in the foreseeable future.

10. Pulse Polio is an immunization campaign established by the government of India to eliminate polio in India by vaccinating all children under the age of five years against the polio virus.

11. The Pradhan Mantri Swasthya Suraksha Yojana (PMSSY) was announced with objectives of correcting regional imbalances in the availability of affordable/ reliable tertiary healthcare services and also to augment facilities for quality medical education in the country by setting up of various institutions like AIIMS and upgrading government medical college institutions.

12. Since there are huge income disparities, therefore, the government has launched several programmes in order to support the financially backward class of the country. As about 3.2 crore people in India fall under the National Poverty line by spending on healthcare from their own pockets in a single year. The most important programme launched by the government is Rashtriya Arogya Nidhi which provides financial assistance to the patients that are below poverty line and are suffering from life-threatening diseases, to receive medical treatment at any government run super specialty hospital/ institution.

13. National Tobacco Control Programme was launched with the objective to bring about greater awareness about the harmful effects of tobacco use and about the Tobacco Control Laws and to facilitate the effective implementation of the Tobacco Control Laws.

14. Integrated Child Development Service was launched to improve the nutrition and health status of children in the age group of 0-6 years, lay the foundation for proper psychological, physical and social development of the child, effective coordination and implementation of policy among the various departments and to enhance the capability of the mother to look after the normal health and nutrition needs through proper nutrition and health education.

15. Rashtriya Swasthya Bima Yojana is a government-run health insurance programme for the Indian poor. It aims to provide health insurance coverage to the unrecognized sector workers belonging to the below poverty line and their family members shall be beneficiaries under this scheme.

How does Oxfam India work to address healthcare

Costly healthcare is pushing millions below poverty line every year, and denies care to many who are already poor. Key essential medicines remain unaffordable and inaccessible to people. Oxfam India has been part of a nationwide process working towards improvements in the delivery of public health services. We are working across states to improve access to healthcare and essential medicines. Here is how:

Oxfam India’s work on Essential Medicines in our intervention regions this year

1. Oxfam India covered 15 districts in Bihar, 14 in Odisha and 10 districts in Chhattisgarh reaching out to over 60,00,000 people in these states with the message of demanding greater access to affordable essential medicines. The campaign was done collaboration with Jan Swasthya Abhiyan (JSA) and other Health Networks. The campaign was designed to create awareness among general mass and strengthen communities’ voice for availing their rights for essential medicines and diagnostic facilities.

2. In Bihar, the name of the campaign on essential medicines was carried out under the tagline of #HaqBantaHai and sub tag of "Struggle from 14 to 40" with an ask to increase the per person, per capita government expenditure on medicines from Rs. 14 to Rs. 40. As a result of the campaign the then Finance Minister, Government of Bihar, committed to provision INR 500 crore in the budget of Bihar for year 2018-19. He committed that will strive to spend Rs. 40 per person, per capita during FY 2018-19. However, due to political instability and elections in Bihar, this commitment did not see the light of the day.

3. In Odisha, over 1000 letters written by the community members were posted to the Chief Minister’s office in Odisha demanding free medicines and free diagnostic services at the health centers, and faster transportation services. Post the campaign spike, the State Health Minister ordered for the display of information including CDMOs contact number in all the public health centers. The national political parties in Odisha invited Oxfam India to make presentation on the campaign in their Economic Affairs Committee meeting. A political party has agreed to include some of the demands in their forthcoming 2019 election manifesto. Due to constant advocacy under access to medicine campaign in Odisha, an enhanced budgetary allocation from Rs.263 Cr. in 2017-18 to Rs.304 Cr. in 2018-19 is provisioned in the budget for the NIRAMAYA Scheme alone. The government has also launched a new scheme for diagnosis called NIDAN in 2018.

4. In Chhattisgarh, in partnership with the state Jan Swasthya Abhiyan, the data generated from active tracking of stock of essential medicines in public hospitals in 56 facilities of 10 districts has been used for state level advocacy with high media outreach. Various stakeholders, like Chhattisgarh Medicine Services Corporation (CGMSC),

Chhattisgarh State AIDS Control Society (CGSACS), CBOs and patients organizations were brought together for joint consultations. During one consultation, the Chhattisgarh Positive People’s Network raised concerns related to shortage and non-procurement of HIV/AIDS medicines and related consumables, as a result of which a three month inventory of the required items were procured and distributed by the state health department. Additionally, through training and survey on medicines, the capacities of civil society organizations have been built around the issue of medicines. Regional consultations have been held in order to build solidarity and a campaign around the Right to health and health equity.
India’s home healthcare market is expected to grow to around $4.46 billion by 2018 and $6.21 billion in 2020, says Cyber Media Research (CMR).

Market for home healthcare services in India to double in a year: report

Largely serviced by unorganized players, start-ups and recent hospital initiatives, India's home healthcare market stood at around $3.20 billion in 2016.

The market for home healthcare services in India—a cheaper and more comfortable option for patients—is set to double in a year’s time, health economists say.

Though in a nascent stage in India, and largely serviced by unorganized players, start-ups and recent hospital initiatives, the market stood at around $3.20 billion in 2016, and is expected to grow to around $4.46 billion by 2018 and $6.21 billion in 2020, according to Cyber Media Research (CMR) Ltd analysis and industry estimates. CMR is an ISO 9001: 2008 company and an institutional member of the Market Research Society of India.

With advancements in information technology and integration with medical electronics, it is now possible to provide high-quality care at home at an affordable price. Additionally, home healthcare services mean more beds available for needy patients.

"Home healthcare services are an extension of hospital services into the patient’s house and providing personalized care by competent professionals. Home healthcare companies work with hospitals to widen their reach, by freeing the beds for new patients while covering almost 70% of all healthcare requirements of a consumer and extending to management of lifestyle and chronic diseases like diabetes, hypertension etc. over a consumer’s lifetime," said Vivek Srivastava, CEO and co-founder of Noida-based HealthCare at HOME, a home healthcare provider.

"Its advantages include cost effectiveness with excellent clinical outcomes as customers end up saving 20-50% costs as compared to regular hospital treatment depending upon the services taken. For instance, ICU services are 50% cheaper than those provided in hospitals. Not to forget, it includes customized care plans prescribed by the patient’s doctor; quicker patient recovery; and professional protocol-led healthcare," he said.

There is tremendous pressure on hospitals in delivering services at their facility, especially in critical care. As per government and private hospital statistics, about 40% of patients admitted in hospitals suffer from chronic diseases such as heart diseases, diabetes, stroke and chronic obstructive pulmonary disease (COPD).

The typical cost of stay in an ICU in a hospital could range between Rs35,000 to Rs50,000 a day. By contrast, setting up an ICU facility at home with equipment and medical expertise would range between Rs7,500 to Rs10,000 a day.

A monthly package of services for recovery from stroke could cost between Rs25,000 to Rs30,000 at home compared to Rs5,000 a day at a hospital, according to estimates from private hospitals. Another argument regarding home healthcare services is lower incidence of hospital-acquired infections.

"There is focused attention to the patient rather than distributed over 10 or more patients, convenience of receiving care in the comfort and familiar surroundings of a home rather than alien environment in a hospital and significantly lower cost when compared to an extended stay in a hospital," said Rajiv Mathur, Founder CCU (Critical Care Unified ) Health Care another home healthcare service provider.

"Interconnectivity through devices and portability of treatments and equipments makes it feasible to provide critical care at the comfortable environs of home. Patients receive individualized care designed to meet their specific needs. Home health care enables people to recuperate in the comfort and privacy of their own home, at a cost savings of 36-50% over hospitalization or nursing home confinement," he said.

Even hospitals are entering the home healthcare market. Max Healthcare, a healthcare provider, recently introduced ‘Max@Home’, its home-based healthcare service offering programme. Max@Home has been launched as a specialized continued care programme, backed by Max Healthcare’s 12-hospital network.

The programme facilitates real-time patient monitoring by connecting doctors, dedicated case managers, trained nursing staff and emergency services through an efficient technology-infrastructure created by Western India Products (WIPRO ), a multinational IT consulting and system integration Service Company.

There will be services to meet a growing demand for long-stay and palliative care even in tertiary specializations like cardiology, oncology, neurology and orthopaedics.

"The demand for at-home healthcare delivery is growing. At the same time, quality post-operative care in familiar surroundings has been observed to enable faster patient recovery. We have plans to deliver the personalized and customizable service offering across Delhi NCR, extending to Mohali Tri-city by the next quarter and Dehradun by 2018," Rajit Mehta, CEO and managing director, Max Healthcare said.

Home healthcare though gaining pace in India is currently not covered comprehensively by health insurance companies. However, the treatment administered at home is only as prescribed by the treating doctor of the patient.

There have been questions on the quality of healthcare at home and whether beds at home can really be a substitute for hospital beds.

"Home healthcare is becoming a brisk business nowadays. As elderly population in the country is increasing very fast and more and more people want to have better social positioning, facilities such as home healthcare seem very flashy at face value and is manifestation of people’s social status," said Arup Mitra, professor, Health Policy Research Unit (HPRU) at Institute of Economic Growth.

"It is in a preliminary stage and may prove to be an illusion in future as there is no guarantee of risks and insurance involved," he said.

My mother has been an incredible source of inspiration in my journey of becoming a nurse. She worked for Ghana’s Ministry of Education, and often took in and cared for children who were in need or unable to get an education. Her humanitarian gesture inspired me to empathize with others, especially with women and children. She cultivated my interest in health promotion, and along the way I’ve seen how the burden of disease is reduced when people are empowered to take control of their health.

I wanted to be a nurse who could communicate effectively and professionally with patients, who takes good care of them, and who respects patients’ privacy. To better prepare myself, I pursued further education in Nursing and Psychology, Public Health, as well as Health Services Administration.

Prior to joining the United Nations, I worked as a registered nursing officer at Ghana’s Ministry of Defence. This experience helped me hone my professional skills and develop empathy for people affected by conflict. In Ghana, the Buduburam refugee settlement sheltered more than 12,000 refugees who had fled Liberia’s two civil wars. Each time I drove past the camp, I felt motivated to improve the living conditions of populations suffering from war. That was when the idea of working for the United Nations came to me.

Back then, I couldn’t find any positions at the United Nations that would allow me to directly work with the refugees in Ghana—but I spotted an opportunity to indirectly help people in other countries also affected by conflict. By joining the medical team in charge of maintaining the health of United Nations staff, I could help the refugees by increasing productivity within the organization.

I applied and was recruited to work at the United Nations Mission in Nepal in 2007. My career with the Organization has since taken me to Kosovo, Congo, Iraq, and right now, Darfur in the Sudan. Working in these areas can be challenging. I remember how vigilant I became when I went on a vacation after the first month in Iraq. Whenever someone in my family banged a door at night, I found myself awake, acting like a soldier on guard. Even so, I have never regretted my decision. I really enjoy my work because I’m fulfilling my dream. Whenever a patient says "thank you" or "God bless you" to me, I feel proud and grateful.

I am enthusiastic about health education for women and children. I have always considered the lack of knowledge as the real poverty. When I was in Iraq, I had the opportunity to volunteer at a health promotion programme initiated by UN Women and the United Nations Development Programme. I joined the Programme because the lack of reproductive health awareness shocked me to the core. As a medical practitioner, a woman, and a mother, I simply needed to do my part to help them, and sharing information is one way of doing so.

My journey with the UN has been so rewarding – but I still look forward to going back home one day to assist with Ghana’s health education. I believe when a country puts more effort into improving health awareness, the national health expenditure decreases, which advances a country’s development. It is another way to impact humanity, just as my mom did when I was a child.

With the advent of HIV and AIDS, many families, including mine, have been affected. As a nurse, it was difficult to see the suffering of infected people and their families: They were neglected, felt abandoned and stigmatized. Even healthcare professionals were so afraid to go near AIDS patients because there was little knowledge of the disease and how one could be infected.

I happened to be one of the first nurses at Bamenda in Northwest Cameroon to undergo training on HIV and AIDS counselling. I wanted to acquire more knowledge on caring for the infected and the affected. I understood that AIDS patients needed to feel loved. They also needed help to resolve family conflicts that arise after diagnosis of infection. That was my role as a consultant for the National Technical Group which was fighting the disease in Cameroon. I also participated in the establishment of local AIDS committees in villages.

Nursing for me is not just a job, it is a calling which I felt ever since I was 13 years old and gave my first blood donation to save a mate’s life. By nature, I am always drawn to the most vulnerable and the under privileged. They are the ones who need you the most.

Before joining the United Nations, I worked in Cameroon for 25 years in various capacities in the field of nursing. I started as State Registered Nurse in a provincial hospital and went through various positions before moving on to become a Senior Nursing Officer.

With this experience, I felt the need to extend my services and expertise to people in other countries, so I applied for the United Nations Volunteer (UNV) programme. I was drawn to the Organization’s humanitarian work.

My first assignment as a UNV was with the Medical Clinic in the United Nations Mission in Sierra Leone in 2005. I was later appointed the Head Nurse of the Clinic in January 2006, and was assigned administrative tasks. Eighteen months later, I applied for a professional position and transferred to the Medical Service of the United Nations Operations in Cote D’Ivoire.

The United Nations Medical Service provides health services to the Organization’s staff. Securing the health of its personnel is a top priority. We take this very seriously, and try to render quality care. As peacekeeping missions are usually in places where there may be a lack of adequate medical facilities, we put in place easily accessible and ready-to-function facilities.

I am based in the Abidjan Clinic, one of three clinics in the Mission. By United Nations categorization, it is a level 1+ clinic, meaning that it is close to the level of a hospital facility. It has an operating theatre, x-ray and dental units. We provide a 24-hour service, with about 120-180 personnel visiting each week for consultation. We provide the first line of care and refer patients to higher level hospitals, if necessary.

As Chief Nurse, it is my responsibility to ensure that the care we provide is acceptable to our personnel. The bulk of my work has to do with administration. I am also involved in arranging medical evacuations, movement of personnel and deployment of medical staff. In addition, I provide counselling for voluntary HIV testing. Sometimes, I accompany patients with serious conditions, who are referred to a higher level hospital in another country or are being repatriated.

What I find interesting about the position is the wider scope of experience I get. It gives me inside knowledge of the policies and rules of the Organization, and the opportunity to be innovative and creative.

It can also be challenging as your colleagues depend on you for their health needs. Not long after I assumed the position, we lost a staff member we had referred to another hospital. It was very difficult to participate in the investigation on possible negligence on the part of the Medical Service.

We are also providing care in a multicultural environment with different religious beliefs. We try as much as possible to respect that by striking a delicate balance between cultural differences and ensuring that staff members get timely care.

For me, it has been fascinating and a very rewarding experience working in United Nations peacekeeping missions. I would advise prospective applicants to make sure they acquire the necessary educational qualification and professional skills – working with the Organization is highly competitive.

Health care

Health care or healthcare is the maintenance or improvement of health via the prevention, diagnosis, and treatment of disease, illness, injury, and other physical and mental impairments in people. Health care is delivered by health professionals in allied health fields. Physicians and physician associates are a part of these health professionals. Dentistry, midwifery, nursing, medicine, optometry, audiology, pharmacy, psychology, occupational therapy, physical therapy and other health professions are all part of health care. It includes work done in providing primary care, secondary care, and tertiary care, as well as in public health.

Access to health care may vary across countries, communities, and individuals, largely influenced by social and economic conditions as well as health policies. Providing health care services means "the timely use of personal health services to achieve the best possible health outcomes" Factors to consider in terms of healthcare access include financial limitations (such as insurance coverage), geographic barriers (such as additional transportation costs, possibility to take paid time off of work to use such services), and personal limitations (lack of ability to communicate with healthcare providers, poor health literacy, low income). Limitations to health care services affects negatively the use of medical services, efficacy of treatments, and overall outcome (well-being, mortality rates).

Health care systems are organizations established to meet the health needs of targeted populations. According to the World Health Organization (WHO), a well-functioning health care system requires a financing mechanism, a well-trained and adequately paid workforce, reliable information on which to base decisions and policies, and well maintained health facilities to deliver quality medicines and technologies.

An efficient health care system can contribute to a significant part of a country's economy, development and industrialization. Health care is conventionally regarded as an important determinant in promoting the general physical and mental health and well-being of people around the world. An example of this was the worldwide eradication of smallpox in 1980, declared by the WHO as the first disease in human history to be completely eliminated by deliberate health care interventions.