By Mr. Aseem Garg, Founder, DCDC
As lifestyle diseases such as hypertension and diabetes continue to affect a large percentage of the population, there is also a rise in related conditions like nephropathy. Unfortunately, End-Stage Renal Disease (ESRD) and CKD (Chronic Kidney Disease) are not rare in India. While the exact figures cannot be ascertained due to the country’s vast population, the prevalence of CKD is approximately 800 per million population.
The disease burden is significantly greater in the country due to a disproportionate socio-economic landscape. As per NITI Aayog’s report, 25.01% of India’s population suffers from multidimensional poverty, with a lack of access to critical services like health and education. It is no surprise, then, that 70% of patients are forced to abandon their dialysis treatment for CKD midway.
Against this backdrop, the following is an overview of how CKD impacts patients, and the need to boost accessibility and affordability to best-in-class dialysis services for patients suffering from the life-threatening illness.
Understanding CKD: The Silent Killer
One of the main reasons why ESRD is a huge cause for concern for the population as well as the healthcare sector is because early chronic kidney disease has no signs or symptoms. It cannot be traced without blood and urine tests, and ultrasounds. While there are risk factors such as blood pressure or diabetes that may prompt doctors to carry out tests for kidney disease, kidney health is often ignored until the condition has worsened. Unfortunately, chronic kidney disease does not just go away and if untreated, and can escalate to total kidney failure, leaving patients no option other than dialysis or a renal transplant to prolong life.
Dialysis is a life-saving procedure when a patient loses 85% – 90% of kidney function. In simple terms, dialysis performs the functions of a healthy kidney by removing extra water, salt, and waste from the blood while balancing the levels of potassium, bicarbonate, and sodium. Doing so helps these toxic elements from building up in the body and improves blood pressure levels to help the patient maintain a good quality of life. Dialysis support is needed throughout life or until a kidney transplant takes place in severe cases.
The Economics of Dialysis
When it comes to dialysis cases in India, the numbers have hitherto been grim. There are over a million patients in the country who need to be dialyzed regularly, and 3,00,000 new patients are added to this tally annually. This boils down to 209 million treatments in India. However, the dialysis sector, predominantly situated in the country’s urban centres, comprises only 20,000 machines that cater to only 8% of the total demand.
Unsurprisingly, dialysis is a costly treatment. The cost of one session ranges from approximately INR 150 at government hospitals to more than INR 3,000 at private hospitals. The costs can be restrictive for a large percentage of Indians. Since people who have access to dialysis can lead a normal life – travelling, going to work, enjoying their hobbies – with a healthy diet and light physical activity – it is important to look at ways to make dialysis more accessible to people, regardless of their background.
Apart from costs, another impediment to regular dialysis is the fact that dialysis facilities in the Indian hinterlands are few and far between. Even today, people have to travel between 50-200 km up to 3 times a week to reach their closest dialysis centre. This only adds to the already exorbitant costs of dialysis that a patient incurs. Many patients may not be able to travel long distances every other day due to their condition.
Fortunately, government and private players are working together to forge a solution.
Proposing a solution: Public-Private Partnerships can lower costs and boost access to Dialysis
The Government of India recognizes and has introduced significant initiatives to address the ongoing issue of an inaccessible dialysis landscape. In 2016, the Prime Minister launched the Pradhan Mantri National Dialysis program to make the life-saving procedure more affordable. Under the program, a Public-Private Partnership (PPP) was deemed not only feasible but also pivotal to ensuring that out-of-pocket expenditure is minimized for CKD patients and their families.
Why does the PPP model work best for a nationwide dialysis program? The answer is simple. To make high-quality dialysis treatments available across district hospitals, we require the convergence of leading private healthcare organizations with world-class facilities and public players with low-cost reach across tier-III, tier-IV, and rural areas. It is by partnering with government organizations that private players can successfully set up their services in the remotest corners of the country.
Apart from low costs, there are other advantages to this model. Leading PPP players establish multiple centres across regions to ensure that every individual can benefit from proximity. They also ensure state-of-the-art infrastructure, consultations with renowned nephrologists, flexible dialysis options, and even access to entertainment to enhance the patient experience.
Such players can also help patients by setting up both haemodialysis and peritoneal dialysis at their homes so that patients can be treated where they are most comfortable. With home dialysis, they can get the right treatment while maintaining their lifestyle. Finally, the expert doctors that are a part of the association can guide individuals about their long-term treatment, such as transplants.
The road ahead: Removing inequity and disparity from kidney health
The establishment of PPP mode dialysis centres across the country is a promising move for CKD patients. With several centres being set up across regions like Andhra Pradesh, Madhya Pradesh, and Bihar, among many others, the demand and supply gap impacting CKD patients is bound to ease over the coming years. With concerted efforts from the government, private players, and the entire medical fraternity, we can ensure that all Indians have access to high-quality dialysis services, with no geographical or economic constraints holding them back from getting the best course of treatment and living long, happy lives.